| 麦尔耶姆 ·苏来曼,肖开提 ·依不拉音,郭飞.小肠出血 63例外科治疗分析[J].安徽医药,2026,30(3):511-515. |
| 小肠出血 63例外科治疗分析 |
| Small bowel bleeding: an analysis of surgical treatment of 63 cases |
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| DOI：10.3969/j.issn.1009-6469.2026.03.016 |
| 中文关键词: 胃肠出血 外科治疗 术中肠镜 出血病因 出血部位 |
| 英文关键词: Gastrointestinal hemorrhage Surgical treatment Intraoperative enteroscopy Etiology of bleeding Bleeding site |
| 基金项目:医药卫生高层次人才培养计划( TSYC202301B146) |
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| 摘要点击次数: 329 |
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| 中文摘要: |
| 目的分析剖腹探查结合术中肠镜在小肠出血中的诊断及治疗中的应用价值，并总结小肠出血的诊治经验。方法收集 2014年 1月至 2023年 3月新疆医科大学第一附属医院接诊的 63例小肠出血病人的临床资料，并对病因、临床表现、检查方法、治疗情况等资料开展回顾性研究。结果该研究包含了 63例病人，其中手术成功 61例， 2例术后死亡( 1例腹主动脉瘤 -空肠瘘导致小肠出血，另外 1例小肠毛细血管扩张症)手术过程中都明确了出血病因。在这些病例中，小肠憩室为最主要的出血原因(占 36.5%)其次是肿瘤(占 20.6%)另有一部，分是由炎症或溃疡所致(占 15.9%)。最常见的出血部位是回肠(占 49.2%)，其次是空肠(，占 44.4%)。诊断方法包，括胶囊内镜、小肠镜、腹盆腔 CT、腹部 CT血管成像( CTA)、数字减影血管造影(DSA)病理、术中肠镜等。其中手术探查 +术后病理检查检出率最高为 100%(59/59)，其次是术中肠镜检出率为 96.3%(26/ 27)，胶囊，内镜检出率为 75%(12/16)。结论小肠憩室与肿瘤是小肠出血的主要病因，现有常规检查因局限性易导致术前诊断率低、误诊风险高；而剖腹探查结合术中肠镜可有效明确出血病因及部位，显著提升小肠出血的诊断准确性、降低漏 /误诊率，在小肠出血的诊治中具有重要的临床应用价值。临床诊治小肠出血时，应重视剖腹探查联合术中肠镜的应用，必要时联合多学科协作，以优化诊治效果。 |
| 英文摘要: |
| Objective To analyze the application value of laparotomy combined with intraoperative enteroscopy in the diagnosis andtreatment of small bowel bleeding, and to summarize the experience in the diagnosis and treatment.Methods The clinical data of 63 patients with small bowel bleeding admitted to The First Affiliated Hospital of Xinjiang Medical University from January 2014 to March2023 were collected, and a retrospective study was conducted on the data including etiology, clinical manifestations, examination meth.ods, and treatment.Results This study included 63 patients, among whom 61 achieved successful surgery and 2 died postoperatively(1 case caused by aortoenteric fistula of abdominal aortic aneurysm and another case small intestinal telangiectasia), with the bleedingetiology clearly identified during all surgical procedures. Among these cases, small bowel diverticula were the most common cause ofbleeding (accounting for 36.5%), followed by tumors (20.6%), and a portion was attributed to inflammation and ulcers (15.9%). Themost frequent bleeding site was the ileum (49.2%), followed by the jejunum (44.4%). Diagnostic methods included capsule endoscopy,small bowel endoscopy, abdominal and pelvic computed tomography (CT), abdominal CT angiography (CTA), digital subtraction angiog.raphy (DSA), pathological examination, and intraoperative enteroscopy. Among them, surgical exploration combined with postoperativepathological examination yielded the highest detection rate of 100% (59/59), followed by intraoperative enteroscopy with a detectionrate of 96.3% (26/27), and capsule endoscopy with a detection rate of 75% (12/16).Conclusions Small bowel diverticula and tumors are the main causes of small bowel bleeding. Conventional examinations currently available, due to their limitations, are prone to lowpreoperative diagnostic rates and a high risk of misdiagnosis. Laparotomy combined with intraoperative enteroscopy can effectivelyidentify the etiology and location of bleeding, significantly improve the diagnostic accuracy of small bowel bleeding and reduce the rateof missed diagnosis and misdiagnosis, thus holding important clinical application value in the diagnosis and treatment of small bowelbleeding. In the clinical diagnosis and treatment of small bowel bleeding, attention should be paid to the application of laparotomy com.bined with intraoperative enteroscopy, and multidisciplinary collaboration should be adopted when necessary to optimize the diagnostic and therapeutic effects. |
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