小肠肿瘤出血11例的诊治分析

Analysis of diagnosis and treatment of small intestinal tumor bleeding

目的探讨小肠肿瘤出血的诊断和手术治疗及预后。方法回顾1990-2010年收治的11例患者资料,根据不同病情,比较不同的检查方法如胃镜、结肠镜、小肠气钡双重造影、数字减影肠系膜动脉造影、剖腹探查、术中内镜检查、全消化道钡餐及螺旋CT血管造影检查、超声在诊断技术中应用情况,分析确定诊断比例及病程与预后关系。结果全消化道造影、内窥镜、肠系膜上动脉造影是诊断和定位小肠肿瘤的主要手段。术中内镜检查和剖腹探查对于小肠肿瘤早期病灶定位诊断成功率高,恶性小肠肿瘤病程长短与预后相关。统计学分析有显著性意义。结论除非有明确的小肠肿瘤病灶,术中内镜检查和剖腹探查是发现小肠肿瘤出血病灶的最佳方法。小肠肿瘤出血治疗应首选手术切除,手术方案、手术方式一般依据肿瘤性质及明确的病变部位来决定。对高度怀疑小肠肿瘤的患者及早剖腹探查可改善预后;对体质弱、严重营养不良患者要采用个体化治疗策略,规避手术风险。

Objective To explore the diagnosis of small intestinal tumor bleeding and surgical treatment and prognosis. Methods To review in 1990 -2010 years ll patients data, according to the different condition,comparing different inspection methods such as gastroscope, colonoscopy, small intestinal pneumobarium double, MRI, digital subtraction mesenteric artery angiography, and laparotomy exploration, intraoperative endoscopic examination, the digestive tract spiral CT angiography, ultrasound in the diagnosis, Analysis confirm the diagnosis proportion and the course and prognosis relation- ship. Results All the digestive tract, MRI,endoscopic and superior mesenteric artery angiography is diagnosis and positioning the principal means of small intestinal tumor. Intraoperative endoscopy and paunch to probe for early diagnosis of small intestinal tumot lesion positioning high success rate,the length of the course of malignant small intestinal tumor associated with outcome. Statistical analysis there are notable. Conclusions Unless there is a specific small intestinal tumor lesion, perioperative, endoscopic check and paunch to probe is found small intestinal tumor bleeding lesions best method. Small intestinal tumor bleeding treatment should be first selection surgery, operation program, the operation method based on general properties and clear tumor lesion site to decide. For highly suspicious of small intestinal tumor patients early caesarean section can improve the prognosis exploration ; Weak on fitness, severe malnutrition patients to make use of the individual treatment strategies ,avoid surgical risk.