血管异常致下消化道出血的诊断与治疗

Diagnosis and treatment of lower gastrointestinal bleeding caused by vascular anomalies

目的提高对血管异常所致下消化道出血的诊断与治疗水平。方法回顾分析因血管异常所致下消化道出血１５例的资料。结果临床表现以血便、黑便为主，８例入院时贫血，２例有休克。经钡餐、纤维内镜、血管造影多项检查，最终经手术或病理确诊。７例肠镜检出阳性５例，１０例肠系膜动脉造影检出８例。血管病变与出血灶位于小肠占６６．７％、右半结肠２０．０％，合并回肠结肠病变１３．３％。全组１３例手术治疗，平均手术次数１．７次。手术及病理证实血管发育不良７例，动静脉畸形４例，门脉高压相关肠血管病变２例。结论下消化道活动性出血，早期肠镜检查与选择性血管造影有助于明确出血部位及诊断。手术切除病变肠段对控制出血有效，复发再出血率低。

Objective A series of 15 consecutive patients with lower gastrointestinal bleeding(LGB) caused by vascular anomalies was retrospectively reviewed. Methods There were 5 males and 10 females with a mean age of 55.9 years.Hematochezia and melena were the most common clinical presentations,hypotension found in two patients at admission.Barium studies,colonoscopic and /or angiographic examinations being performed to detect the bleeding sources.T5HZResults Bleeding site was identified by colonoscopy in 5/7 cases, by angiography in 7/10 and by barium studies in none.Hemorrhage came most frequently from small intestine(66.7%) and right hemicolon(20%).Pathology showed bleeding due to angiodysplasia in 7 instance ,arteriovenous malformation in 4,from portal hypertensive enteropathy and small bowel varices in 2. 13 patients were cured surgically, the rest two died of postoperative complications. Conclusion With early colonoscopy and /or selective angiography at bleeding episode the identification rate of source of LGB would increase.Surgical resection of the involved bowel segment was effective to control LGB and prevent recurrence.