腹主动脉重建后肠出血的诊断和治疗

目的探讨腹主动脉重建后肠出血的诊断和治疗方法。方法回顾分析6例患者的临床资料，总结其病因、临床表现、影像学资料、诊断和手术中的情况。结果6例均在全身麻醉下剖腹探查，术中见均为腹主动脉一小肠瘘所致肠出血。在瘘口上下方阻断主动脉，控制出血后行动脉瘘口修复、肠瘘口周围小肠部分切除术。1例术后11d死于多器官功能衰竭；5例获得临床治愈。随访1～10年，1例手术后1年死于脑出血，1例肿瘤复发再次术后1年5个月死于急性心肌梗塞，余3例随访5年以上均健康存活。结论主动脉重建后消化道出血的原因均为主动脉-肠瘘，结合影像学检查可得出正确诊断，手术修复主动脉和肠道瘘口是治疗该病可靠的治疗方法。

The diagnosis and treatment of intestinal bleeding after aortic reconstruction

Objective To investigate the method of diagnosis and treatment of patients with intestinal bleeding after aortic reconstruction. Methods The clinical data of 6 patients who had intestinal bleeding after aortic reconstruction from 1995 to 2006, including the etiology, chnical manifestations, imaging data, diagnosis and operative findings, were analysed retrospectively. Results All cases underwent repair of aortoenteric fistulas and partial enterectomy after aortic occlusion under general anesthesia. The cause of intestiral bleeding in all cases was abdominal aorto-enteric fistula. One case died from multiple organ system failure on the 11 th day after operation. Five cured cases were followed-up for 1 - 10 years. The results showed that 3 cases were alive longer than 5 years and 2 cases died from acute myocardiac infaction and intracerebral hemorrhage more than 1 year after operation respectively. Conclusions The correct diagnosis of aortoenteric bleeding may be confirmed by combining clinical manifestation with imaging data. Repair of the aortoenteric fistula is a rational and reliable method in treating this complicated illness.