术中内镜在急性小肠大出血急诊剖腹探查术中的应用价值

目的探讨术中内镜在急性小肠大出血急诊剖腹探查术中的应用价值及其安全性。方法对26例急性小肠大出血须急诊剖腹探查的患者进行了术中内镜检查，总结和评价其应用价值。结果25例患者通过术中内镜明确了出血的原因，其阳性检出率达96，2％：其中十二指肠水平部平滑肌瘤2例，十二指肠水平部Dieulafoy病1例，小肠平滑肌瘤5例，小肠平滑肌肉瘤2例，回肠淋巴瘤2例，回肠末段溃病3例，小肠海绵状血管瘤4例，小肠动静脉畸形5例，胰空肠吻合口出血1例。检查平均用时15min，且无1例发生术中内镜相关性并发症。所有患者都根据术中内镜诊断进行了相关手术治疗，术后无1例出现消化道再出血。结论急性小肠大出血须急诊剖腹探查时，术中内镜的应用不仅可提高病变检出率，而且定性准确、安全快速。

The application of intraoperative endoscopy during the emergency exploratory laparotomy in the patients with acute massive small intestinal bleeding

Objective To evaluate the application of intraoperative endoscopy during the emergency exploratory laparotomy in the patients with acute massive small intestinal bleeding.Methods Twenty-six patients with acute massive small intestinal bleeding were examined by intraoperative endoscopy during the emergency exploratory laparotomy and the clinical data were analyzed.Results The hemorrhagic reasons were clarified in 25 patients(96.2%) through the application of intraoperative endoscopy.Of the 25 patients,the results showed that 2 cases were with duodenal leiomyoma,1 case duodenal Dieulafoy' disease,5 cases small bowel leiomyoma,2 cases small bowel leiomyosarcoma,2 cases ileum lymphoma,3 cases ileum ulcer,4 cases small bowel cavernous hemangioma,5 cases small bowel arteriovenous dysmorphosis and 1 case pancreaticojejunostomy cut bleeding.The average examination time was 15 min and no complications related to intraoperative endoscopy occurred in all patients.Conclusion The application of intraoperative endoscopy,which may increase the detection rate,is efficient and safe during the emergency exploratory laparotomy in the patients with acute massive small intestinal bleeding.