小肠出血的诊断和治疗(附76例报告)

目的探讨小肠出血的病因、诊断和治疗措施。方法对我院近8年收治的病因明确的76例小肠出血病人的临床资料进行回顾性分析。结果本组小肠出血病人肿瘤占首位(37/76),其中包括小肠间质瘤32例,其余依次为美克尔憩室(21/76)、血管病变(15/76)及异位胰腺(3/76)。经数字减影血管造影诊断21例,小肠气钡双重对比造影诊断13例,腹腔核素扫描诊断11例,小肠镜检查诊断6例,腹腔镜探查诊断21例,剖腹探查诊断4例。全组病人均经手术治疗,手术方式以包括病变在内的小肠部分切除术为主(68/76)。随访时间6月～5年,临床疗效满意。结论气钡双重对比造影、核素扫描、数字减影血管造影、腹腔镜探查及剖腹探查是诊断小肠出血的主要手段。包括病变在内的小肠部分切除术是治疗小肠出血最有效方法。

Diagnosis and treatment of small intestinal bleeding: Analysis of 76 cases

Objective To investigate the causes, diagnosis and treatment procedures of small intestinal bleeding. Methods The clinical data of 76 cases of small intestinal bleeding confirmed by surgery and postoperative pathology was analyzed retrospectively in recent 8 years in our hospital. Results Neoplasm was the first cause of small intestinal bleeding (37/76) in these patients of this group, including 32 cases of small intestinal stromal tumor, followed by small intestinal diverticulum (21/76), angiodysplasia (15/76) and ectopic pancreas (3/76). Among these patients, 21 cases were diagnosed by digital subtraction angiography (DSA), 13 by double contrast barium meal examination, ll by radionucleide scanning of abdominal cavity, 6 by electric encloscopy, 21 cases by laparoscopic laparotomy and 4 cases by exploratory laparotomy. All patients were treated by surgical operation and the main operative procedure was intestinal segmentectomy including injured intestinal segment (66/76). Duration of Follow-up was from 6 mouths to 5 years. No further episode of small bowel bleeding and complications occurred in these patients of this group. Conclusion Neoplasm, especial small intestinal stromal tumor, is the most common cause of small intestinal bleeding, and other causes are small intestinal diverticulum, angiodysplasia and ectopic pancreas. A combination of double contrast barium meal examination, radionucleide scanning, DSA, laparoscopic laparotomy and exploratory laparotomy are the main procedures to diagnose small intestinal bleeding. Surgical management, mainly intestinal segmentectomy, is the most effective procedure for treating small intestinal bleeding.