肠道血管畸形的诊断和治疗

Diagnosis and treatment of intestinal vascular malformation

目的探讨肠道血管畸形的诊断和治疗方法。方法对29例肠道血管畸形的临床资料进行回顾性分析。结果本组以反复性、间歇性血便为主要临床表现。17例患者经19例次选择性肠系膜血管造影、7例经纤维结肠镜、2例经单光子发射电子计算机断层扫描(ECT)、3例行剖腹探查得以确诊。5例非手术治疗,24例行手术治疗。手术患者无死亡者,亦未发生术后并发症。随访20例(69.0%),再出血4例,其中非手术组3例、手术组1例。结论(1)选择性肠系膜血管造影是诊断本病的最佳方法;(2)外科手术是治疗肠道血管畸形出血的最有效方法;(3)术前和术中的准确定位是手术成功的关键。

Objective To evaluate the diagnosis and treatment of intestinal vascular malformation. Methods Clinical data of 29 patients with intestinal vascular malformation were reviewed retrospectively. Results Repeated intermittent hematochezia was the most common manifestation. The diagnosis was confirmed by selective mensenteric artery angiography in 17 cases for 19 times, fibercolonoscope in 7 cases, ECT in 2 cases and abdominal exploration in 3 cases. Five patients received conservative treatment. Surgical treatment was performed in 24 patients for 25 times. No operative death and postoperative complication occurred. Conclusions Selective mesenteric angiography is the best diagnostic method. Surgical management is the most effective treatment for intestinal vascular malformation. Accurate localization before and during operation is the key to treat this disease successfully.