下消化道出血11例诊治体会

目的探讨不明原因下消化道出血的手术诊治体会。方法回顾性分析10年间经内镜、血管造影、增强CT扫描及核素扫描均不能明确下消化道出血部位及原因、由于反复出血或出血凶猛而采用剖腹探查诊治者11例的临床资料。结果最常见的出血原因是血管发育不良或畸形(5例),其次,小肠憩室2例,小肠平滑肌瘤1例,3例原因不明。最终的手术方式主要是右半结肠切除(7例),其他有病变小肠段切除3例及结肠次全切除1例。死亡率27.3%,再出血率18.2%。结论原因不明的下消化道出血,多数病人可以通过剖腹探查明确诊断及治疗,应及时手术。

Diagnosis and treatment of 11 cases lower gastrointestinal bleeding

Objective To evaluate the experience in diagnosis and treatment of patients with obscure lower gastrointestinal bleeding. Methods A retrospective review was performed on 11 cases of operations for repeated and（or） massive lower gastrointestinal bleeding during a 10-year period,where the bleeding point could not be localized by endoscopy, angiography, multi-slice spiral CT even scin- tigraphy before surgery. Results The frequent origin of bleeding was angiodysplasia or malformation in 5 cases, followed by small bowel diverticula in 2 cases, small intestinal leiomyoma in 1 case. The bleeding cause was obscure in 3 cases. The segmental resections were performed most frequently（7 right hemicolectomies）,3 cases received small bowel segmental resections, and 1 received subtotal co- lectomy. Perioperative mortality was 27. 3 ~, and incidence of re-bleeding was 18.2 %. Conclusion The origin of most patient with obscure lower gastrointestinal bleeding could be localized and most patients could be treated by operation exploration. Surgical operation should be performed as soon as possible.