肠道动静脉畸形的诊断与治疗8例

Diagnosis and treatment of arteriovenous malformation of gastrointestinal tract: an analysis of 8 cases

目的:总结肠道动静脉畸形导致消化道出血的临床诊断及治疗过程.方法:对我院1999-12/2005-01收治的8例肠道动静脉畸形导致消化道出血患者的临床资料进行回顾性分析.结果:本组8例,5例由于不明原因出血(大便潜血试验为阳性)先后行胃镜检查12次,均未见出血灶;血管造影5例,其中3例明确诊断;另2例结合术中内镜检查发现病灶,此5例行病变肠段切除病理证实为小肠单发或多发血管畸形.3例先后行盲目手术(盲目胃大部切除术和盲目剖腹探查术)共5次,均未解决根本问题,其中2例行2次介入栓塞治疗成功;另1例死于大出血.7例患者随访6-66mo,1例死于脑出血,其余6例在随访中.结论:血管造影及术中内镜检查有利于发现肠道动静脉畸形病灶,以便更准确的确定病变部位从而成功切除.

AIM： To summarize the clinical diagnosis and treatment of gastrointestinal hemorrhage induced by arteriovenous malformation of the gastrointestinal tract. METHODS： From December 1999 to January 2005, 8 patients were diagnosed with arteriovenous malformation of the gastrointestinal tract in our hospital, and their clinical data were retrospectively analyzed. RESULTS： Of the 8 patients, enteroscopy was totally performed 12 times on 5 patients due to the hemorrhage of unknown reasons, but no lesions were found. Artedovenous malformations were confirmed in 3 cases by angiography and two by angiography integrated with intraoperative endoscopy. Blind surgeries were totally performed 5 times on 3 patients, and therapeutic embolization was successfully followed on 2 of them. One case died of severe hemorrhage. The 7 patients were in the follow up for 6-66 mo, and 1 died of cerebral apoplexy. CONCLUSION： Angiography and intraoperative endoscopy are more effective in the diagnosis of arteriovenous malformation of the gastrointestinal tract.