144例下消化道出血临床分析

Clinical Analysis of 144 Cases of Lower Gastrointestinal Hemorrhage

目的 分析下消化道出血的临床特征 ,提供对该病的诊断和治疗经验。方法 对 14 4例下消化道出血患者的一般资料、临床表现、结肠镜检及血管造影等改变进行分析。结果 14 4例下消化道出血患者经结肠镜检、病理检查及血管造影证实病因分别为炎症性肠病 4 8例 (33.3% ) ,憩室 2 6例 (18.0 % ) ,息肉 2 4例(16 .5 % ) ,结肠癌 2 1例 (14 .6 % ) ,血管病变 16例 (11.1% ) ,其它病变 9例 (6 .2 % )。按出血病灶部位分 ,12 3例(86 .1% )位于左半结肠 ,19例 (12 .5 % )位于右半结肠 ,2例 (1.4 % )位于小肠。经用立止血肌注、去甲肾上腺灌肠、支持治疗后 ,117例 (81.2 % ) 3天内出血停止 ,4例行选择性动脉栓塞出血立即停止 ,其中 1例因肠坏死死亡 ,其余 2 3例出血时间超过 3天。结论 下消化道出血大部分病例通过结肠镜检、病理检查、选择性动脉造影可以明确原因 ;用立止血肌注、去甲肾上腺素灌肠取得较好疗效。选择性动脉栓塞止血效果确切 ,但有肠坏死危险。

Objective To facilitate the diagnosis and therapy by studying the clinical features of lower gastrointestinal hemorrhage. Methods General status, clinical manifestations and laboratory examinations of 144 patients with lower gastrointestinal hemorrhage were reviewed. Results 144 patients with lower gastrointestinal hemorrhage were confirmed by endoscopy and athomorphology and selective arteriography. The incidence of inflammatory bowel disease,diverticulum,polyp, carcinoma of colon vascular pathological changes and other lesions were 33.3%,18.0%, 16.5%, 14.6%, 11.1% and 6.2% respectively. The incidence of hemorrhagic position in left half colon, right half colon and small intestine were 86.1%,12.5% and 1.4% respectively. 117 cases treated by Reptilase and noradrenalin enema were cured in 3 days.The bleeding in 4 patients treated by selective artery embolism were stoped immediately in which only one died from necrosis of intestines. Conclusion The pathogenicity of most patients with lower gastrointestinal hemorrhage could be confirmed by endoscopy,pathomorphology and selective arteriography. The curative effect of reptilase and noradrenalin clusis were preferable. The selective artery embolism had strong hemostatic effect,but could lead to necrosis of intestines.