腹腔镜联合影像学检查在治疗小肠出血中的临床应用价值

Clinical value of laparoscopes combined imaging examinations in precision treatment of small intestinal bleeding

目的 探讨在小肠出血患者中应用影像学检查准确定位指导腹腔镜精确手术治疗的应用价值.方法 回顾性分析2011年1月-2015年12月间收治的19例小肠出血病例的临床资料.患者入院后均先行胃镜或结肠镜排除上消化道出血和结直肠出血,明确为小肠出血.根据出血量分为急性大量出血、慢性显性出血和慢性隐性出血,分别或联合进行MSCT平扫及CTA、全消化道钡餐造影、胶囊内镜、DSA等检查.依据病因给予急诊或择期腹腔镜手术治疗.结果 19例患者均经手术治疗痊愈,其中择期手术16例(84.2％)、急诊手术3例(15.8％);单纯腹腔镜手术7例(36.8％)、导管注入垂体后叶素+腹腔镜手术8例(42.1％)、选择性插管栓塞+腹腔镜手术4例(21.1％).结论 腹腔镜联合影像学检查在精准治疗小肠出血具有诊断明确、定位准确、疗效确切、创伤微化等优点,具有临床应用价值,值得推广.

Objective To investigate the clinical value of laparoscopes located accurately by imaging examinations in precision treatment of small intestinal bleeding.Methods The clinical data of nineteen patients with small intestinal bleeding from Jan.2011 to Dec.2015 was analyzed retrospectively.Upper gastrointestinal hemorrhage and colorectal bleeding were excluded in advance by passing gastroscopy and colonoscopy before small intestinal bleeding was diagnosed.According to the bleeding,it was divided into acute massive bleeding,chronic visible bleeding and chronic occult bleeding.MSCT,CTA,whole alimentary tract barium meal,capsule endoscopy and DSA were selected separately or combined.According to the cause of bleeding,an emergency or selective laparoscopic operation was given.Results Nineteen patients were all cured.Sixteen cases(84.2％) underwent selective operation and three cases (15.8％)underwent emergency operation.Seven cases (36.8％)underwent laparoscopic operation only.Eight cases (42.1％) selected treatments of pituitrin and laparoscopic operation.Four cases (21.1％) underwent selective and superselective mesenteric arterial embolization therapy combined laparoscopic operation.Conclusions Laparoscopes combined imaging examinations has advantages of clear diagnosis,accurate location,definite therapeutic effect and minimally invasive.It is worthy of extending in clinic.