术中肠镜对小肠血管畸形诊疗价值的研究

Clinical value of intraoperative enteroscopy for diagnosis and treatment of intestinal vascular malformation

目的探讨术中肠镜对小肠血管畸形的诊治价值。方法回顾性分析2003年1月至2005年1月南京大学医学院附属鼓楼医院收治并手术确诊的17例小肠血管畸形的临床资料。结果17例病人均以反复黑便或血便等消化道出血为主要临床表现；术前均经胃镜检查排除胃十二指肠出血；结肠镜检查排除下消化道（结肠及直肠）出血；术前均行胶囊内镜检查，其中诊断小肠血管畸形10例（10／17），不能明确诊断或漏诊7例（7／17）。17例病人均行剖腹探查，术中肠镜检查发现点状或片状黏膜血管扩张或出血点，分布于整个小肠，病变最多达18处，最少2处。行点状切除1例，点状＋楔形切除7例，点状＋肠段切除4例，楔形切除3例，肠段切除2例。手术切除标本行病理检查均证实为小肠血管畸形。17倒病人随访2—4年，平均33个月，无一例发生再出血。结论术中肠镜检查对小肠血管畸形具有重要价值，可对小肠血管畸形做出准确定性诊断，是诊治小肠血管畸形的主要手段。

Objective To evaluate the diagnostic and therapeutic value of intraoperative enteroscopy in patients with intestinal vascular malformation. Methods The clinical data of 17 cases of intestinal vascular malformation admitted from January 2003 to January 2005 in Affiliated Drum Tower Hospital of Medical School of Nanjing University were analyzed retrospectively. Results All cases received preoperative gastroscopy examination to exclude any gastric-duodenal bleeding, as well as colonoscopy examination to exclude lower digestive tract （ colon and rectum） bleeding. The capsule endoscopy examinations were also carried out with the diagnosis of intestinal vascular malformation （10/17） and obscure gastrointestinal bleeding （7/17）. All the cases had the indication of exploratory laparotomy. The operations and the intraoperative enteroscopy were carried out. All the postoperative specimen were proved to be intestinal vascular malformation by pathological examination. All the cases were followed up for 2 - 4 years with an average of 33 months and no rehaemorrhagia occurred. Conclusion Intraoperative enteroscopy could afford accurate qualitative and localized diagnosis, so the intraoperative enteroscopy has an extremely important value in the diagnosis and treatment of intestinal vascular malformation, and could serve as a main means in the future.