小儿小肠出血的诊断及治疗

The Diagnosis and Treatment of Small Bowel Bleeding

本文总结了1955年～1986年收治的小儿小肠出血59例.出血呈多种形式,可发生于任何年龄,临床表现无特异性,病理以美克尔憩室及肠重复畸形多见.出血或大便潜血阳性时通过吞线试验、钡餐、钡灌肠、十二指肠镜和结肠镜检查排除十二指肠、胆道以上及结肠出血,即可考虑为小肠出血.反复大出血或严重贫血者应进行手术探查,大出血不止者需立即探查出出血肠管,可采用分段盐水灌洗及台上透光试验,若仍不能确定病灶,则于回肠下1/3行造瘘术,以便进一步观察出血部位及行局部止血措施.

In 1955-1986,59 children with small intestine bleeding were treated.Bleeding in various forms occured in all age groups.The symptoms and signs have no specific significance.The Meckel's diverticulum and the intestinal duplication are the most common causes of bleeding in children.After the conventional diagnostic procedures including 'string test',upper gastrointestinal barium meal,barium enema,duodenoscopy and coloscopy,hemorrhage from the upper G-I tract including esophagus,stomach,duodenum and biliary tract or from color can usually be ruled out,a diagnosis of small intestine bleeding will be suspected.Exploration should be recommended for repeated bleeding or persistant anemia.For uncontrolled massive bleeding,immediate exploration should not be delayed.Segmental intraluminai lavage and extraluminal illumination test may sometimes demonstrate the bleeding site.If no active bleeding found,an ileostomy at the lower third of the blood-containing intestine is performed for direct drainage of the bowel,later observation and local application of some hemestatic measures.