少见原因致下消化道大出血22例临床分析

Diagnosis and treatment of massive lower gastrointestinal bleeding

目的探讨少见原因引起下消化道大出血的临床诊治方法。方法回顾近十年来由外科诊治的下消化道大出血患者22例临床资料,分析少见原因导致的下消化道出血的临床特征、检查及治疗方法。结果选择性血管造影阳性检出率为75.0%(12/16),超选择性血管造影置钢丝标记定位准确率100.0%(4/4)。纤维结肠镜阳性检出率25.0%(5/20)。22例中血管畸形16例(72.7%),小肠间质瘤4例(18.2%),结肠憩室2例(9.0%)。出血病灶位于小肠13例(59.1%),位于大肠9例(40.9%)。介入栓塞治疗术治愈血管畸形12例(54..5%),其余病例手术治愈10例(45.5%)。结论选择性血管造影对下消化道出血病灶定位价值很高,经动脉导管放置钢丝标记出血部位对术中找出病灶所在肠段有积极意义,介入栓塞治疗术是血管畸形的首选治疗手段,外科手术是治疗下消化道大出血必要而有效的治疗手段。

Objective To explore the diagnosis and treatment of massive lower gastrointestinal bleeding because of the rare reasons. Methods A retrospective review was performed on 22 cases for massive lower gastrointestinal bleeding during a 10-year period, where the bleeding point could be localized by angiography, endoscopy and surgery. Results The sensitivity of angiography, endoscopy was 75% （12/16）, 25% （5/20）, respectively. Vascular malformations were the most common causes of massive lower gastrointestinal bleeding accounting for 72.7% （16/22）. Small intestinal leiomyoma accounted for 18.2% （4/22）. Diverticulosis colon accounted for 9% （2/22）. Bleeding site in jejunum and （or） ileum was the most common accounting for 13 cases （59.1%）. Bleeding in colon and （or） rectum accounted for 9 cases （40.9%）. Interventional embolization was done to 12 cases of vascular malformations. Exploratory laparotomy was done to the other 10 patients. Conclusion Angiography is the best examination for the diagnosis of massive lower gastrointestinal bleeding. Interventional embolization is the best treatment for vascular malformations. And surgery is an essential and effective treatment.