急性下消化道大出血的诊断和治疗

目的探讨急性下消化道大出血的诊断和治疗方法。方法对本院25例急性下消化道大出血的临床表现,特殊检查(如纤维胃镜、结肠镜、气钡结肠造影、急诊选择性腹腔动脉造影以及核素扫描)进行了分析和对比。结果选择性腹腔动脉造影和核素扫描的阳性诊断率分别为78.6%和86.4%,而气钡结肠造影的阳性率为67%,急诊结肠镜检查的阳性率仅为41%。结论尽管急性下消化道大出血的最有效的诊断方法是选择性腹腔动脉造影和核素扫描,但急诊肠道镜检查仍应为下消化道大出血的常规检查。如果血管造影疑为肠血管性疾病出血时则应保留导管,术中注入亚甲兰有助于术中的定位诊断,且术中肠道镜检查也可提高诊断率。

Diagnoses and treatment of acute massive hemorrhage of the lower digestive tract

Objective To study the diagnoses and treatment in 25 cases with the massive lower gas- trointesinal (LGI)hemorrhage.Method The clinical symptoms and the results of physical exminatinons (include gastroscopy,colonscopy,air contrast bariun enema,emergent selective arteriography and radionu- clide scan ect.) of 25 patients with acute massive LGI hemorrhage have been analysed and contrasted.Result The consequences indicated that selective arteriography and radionuclide scan had diagnosed massive LGI hemorrhage in 78.6% and 84.6% of patients,and that air contrast bariun enema had yield a diagnoses in 67%,the colonscopy had yield a low level diagnoses in 41%.Conclusion selective arteriography and ra- dionuclide scan were the most effective ways to diagnose the massive LGI hemorrhage,however,colonscopy still should be the routine examination,ff intestinal hemorrhage is suspected when arteriography is being pro- cessed,a highly selective angiographic placement catheter must be reserved and injected methylene blue dye to help to localize the bleeding site intraoperatively.Operation is the main treatment of massive LGI hemor- rhage,and colonscopy also should be performed intraoperatively to increase the diagnostic rate.