小肠出血60例外科诊治体会

Diagnosis and surgical treatment of small intestinal haemorrhage

目的探讨小肠出血的诊治方法。方法收集本科1997年1月至2011年4月诊治的60例小肠出血患者临床资料进行回顾性分析。结果所有病例均行胃镜、纤维结肠镜,排除胃、十二指肠球部及结直肠病变,其中30例行数字减影血管造影(DSA),检出13例(43.3%);99mTc-RBC核素(ECT)检查26例,检出12例(46.2%);胶囊内镜(CE)检查10例,5例获得定性定位诊断(50%);30例术前诊断困难行剖腹探查确诊,其中腹腔镜探查确诊5例,12例结合术中肠镜完成,剖腹手术的确诊率达100%。所有病例行手术治疗,无围手术期死亡病例,54例获得随诊,随诊时间2个月～8年,均未再发小肠出血。结论小肠出血的定位定性诊断存在较大困难,DSA、ECT及胶囊内镜的诊断价值有限,如有手术指征应积极手术探查,必要时结合术中肠镜可提高诊断率和治愈率。

Objective To investigate the diagnosis and treatment of small intestinal haemorrhage. Methods The diagnosis and treatment of 60 cases of small intestinal haemorrhage between January 1997 and April 2011 were analyzed retrospectively. Results The diseases of stomach, duodenal bulb, colon and rectum were eliminated by gastroscope and fibrocolonoscope. Among the patients, 30 cases were examined using DSA, and 13 cases （43.3%） were detected; 26 patients were examined using ECT, and the detection rate was 46.2%; capsule endoscopy was performed in 10 patients and 5 were detected （50%）. The last 30 cases were diagnosed by surgery, which were difficult to make a definite diagnosis, including 5 cases per- formed laparoscopic approach and 12 patients were performed enteroscope examination during operation, and the detection rate was 100%. All the patients were finally performed operation with no mortality, and there were no reeidivation in the 54 cases which were followed up 2 months to 8 years. Conclusions There were difficulties in the level and qualitation diagnosis of small intestinal haemorrhage. The diagnostic value of DSA, ECT and enteroscope are limited, operation should be taken actively when the indication is clear-cut and enteroscope examination during operation could be valuable.