剖腹探查对急性下消化道大出血的诊断价值  

The role of exploratory laparotomy in diagnosis of severe acute lower gastrointestinal hemorrhage

作　　者：唐瑾[1] 李璟[1] 何美蓉[1] TANG Jin;LI Jing;HE Mei-rong(Department of Gastroenterology,Nanfang Hospital,Southern Medical U-niversity,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院消化内科,510515

出　　处：《现代消化及介入诊疗》2018年第2期149-152,共4页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：广东省胃肠疾病研究中心(2017B02029003)

摘　　要：目的探讨剖腹探查对急性下消化道大出血的诊断价值并分析急性下消化道大出血的病因。方法回顾2004年1月至2017年1月我院因急性下消化道大出血住院,并最终行剖腹探查的92例患者病历资料,对其出血定位、病因及相关辅助检查等进行分析。结果术前成功定位出血灶者63例,术前诊断未明者29例,经剖腹探查确诊者24例(82.8%)。剖腹探查确诊并行手术治疗者87例(94.6%),其主要病因为小肠憩室(24例)和小肠间质瘤(17例);手术治愈84例(91.3%)。结论剖腹探查对急性下消化道大出血可取得较满意的诊治效果,但术前尚需完善出血定位检查为手术提供依据,避免不必要的盲目探查。Objective To investigate the value of exploratory laparotomy in diagnosis of severe acute lower gastrointestinal hemorrhage, and analyze the etiology of severe acute lower gastrointestinal hemorrhage.Methods Data of 92 patients admitted with severe acute lower gastrointestinal hemorrhage and eventually received laparotomy between January 2004 and January 2007 were retrospectively analyzed. Results Patients in this study were definitely diagnosed in 63 cases（68.5%） before exploratory laparotomy, the diagnosis of remaining 29 cases was uncertain before surgery, but among them there were 24 cases（82.8%） confirmed by exploratory laparotomy. Finally, 87 cases（94.6%） were diagnosed successfully and received surgical treatment.The main etiology was small intestinal diverticulum（24 cases, 26.1%） and small intestinal stromal tumor（17 cases, 18.5%）. The cure rate was 91.3%（84 cases）. Conclusion Exploratory laparotomy can make a satisfactory diagnosis and treatment for acute lower gastrointestinal hemorrhage, but it is necessary to improve the location of bleeding before operation to provide the basis for the operation and avoid unnecessary blind exploration.

关 键 词：急性下消化道大出血 剖腹探查 内镜 诊断 病因 

分 类 号：R57[医药卫生—消化系统]