小肠血管畸形的治疗进展

Progress in the treatment of small bowel vascular malformation

小肠位于全消化道中间位置,因其位置隐匿,常规内镜检查难以探及。小肠出血量小时,因临床症状轻微,容易被忽略,出血量大时,常危及生命。早期识别小肠出血(small bowel bleeding,SBB)部位及确定SBB病因对临床治疗具有重要意义。小肠可视化内镜检查设备的出现和发展为SBB的诊治带来了新的革命。内镜下识别SBB的病因多样,包括血管病变、肿瘤、憩室等。其中,血管畸形是SBB的主要病因,包括血管扩张、杜氏溃疡及动静脉畸形。药物治疗、介入栓塞及外科手术曾是小肠血管畸形出血的主要治疗选择。而如今,内镜技术的发展使内镜下治疗逐渐成为小肠血管畸形的一线治疗方式。这四类治疗在小肠不同血管病变类型各有千秋,近期研究比较了这四类不同治疗选择在小肠血管畸形患者中的优劣,为临床决策提供依据。

The small bowel is located in the middle of the digestive tract and it is difficult to be detected by conventional endoscopy because of its hidden position.In the case of less blood loss,it is easy to be ignored due to mild clinical symptoms;large bleeding volume,often life-threatening.Early identification of the site and etiology of small bowel bleeding(SBB)is of great significance for clinical treatment.The invention and development of endoscopy equipment of small bowel has brought a new revolution in the diagnosis and treatment of SBB.The etiologies of SBB can be classified into vascular lesions,tumor,diverticulum and so on.Among them,small bowel vascular malformation is the main cause of SBB,including angiectasis,Dieulafoy's ulcer and arteriovenous malformation.Drug therapy,interventional embolization and surgery are the main treatment options for small bowel vascular malformation bleeding.Nowadays,the development of endoscopic hemostasis technology makes endoscopic therapy gradually become the first-line treatment for vascular malformation in small bowel.These four types of treatment have their own advantages and disadvantages in different vascular lesions in small bowel.Recent studies have compared the advantages and disadvantages of these four types of treatment options in patients with small bowel vascular malformation,providing evidences for clinical decision-making.