【Abstract】 Objective To evaluate the detection and localization of obscure lower gastrointestinal bleeding by using SPECT/CT and intraoperative endoscopy. Methods Twenty-six cases of patients with obscure lower gastrointestinal bleeding were analyzed retrospectively. Results The positive detection rate of SPECT/CT was 88.5%. All 26 patients (100%) were identified the bleeding source by using intraoperative endoscopy. No recurrence was found during 1-24 months follow-up. Conclusion SPECT/CT examination should be chosen firstly for patients with obscure lower gastrointestinal bleeding in order to localize the bleeding site roughly. Intraoperative endoscopy can localize the bleeding site accurately in patients who undergoes operation.
目的：探討DSA診斷小腸血管畸形的價值。方法：本文分析21例小腸血管畸形患者的臨床及DSA特征，其中男性14例，女性7例，所有患者均行腸系膜上、下動脈造影。結果：臨床特征：①急性消化道出血為主癥狀；②常規檢查一般為陰性；③血紅蛋白含量短期內降至4～6 g/mL。DSA特征：①動靜脈瘺；②局部腸壁染色增濃；③局部血管異常增多，結構紊亂。其中12例進行了動脈導絲栓塞，2例栓塞后出血，進行外科手術切除。結論：DSA是診斷血管畸形所致小腸出血的最有效的方法，動脈導絲栓塞是安全，有效的治療方法，同時為外科手術切除提供的正確部位。
目的 探討Abernethy畸形致下消化道出血的診斷及治療方法。方法 回顧1例Abernethy畸形患者的診治情況，并結合相關文獻進行分析。結果 血管造影確診后經積極術前準備，行剖腹探查、乙狀結腸造瘺術，術后3周開始給予中藥保留灌腸至術后7周，6個月關閉造瘺,3周后繼續輔以中藥保留灌腸4周。患者順利恢復出院，隨訪9個月未再次出血。結論 正確的診斷及合理的治療方案是救治的關鍵。
【Abstract】Objective To discuss the clinical significance of postoperative application of gastrointestinal decompression after anastomosis of lower digestive tract. Methods Three hundred and sixty-eight patients undergoing excision and anastomosis of lower digestive tract were divided into two groups: the group with postoperative gastrointestinal decompression and the group without it. The clinical therapeutic outcomes and incidences of complications were compared between the two groups. Results The volume of gastric juice in the decompression group was about 200 ml every day after operation. Both groups had a smaller abdomenal circumference before operation than after operation （P＜0.001）. No difference in the time of first passage of gas from anus and defecation after operation was found between the two groups. The incidence of complications in the decompression group was obviously higher than that of non-decompression group (28.0% vs. 8.2%, P＜0.001); the incidence of pharyngolaryngitis of the former was up to 23.1%. There was also no difference found between these two groups regarding the hospital stay after operation.Conclusion The present study shows that application of gastrointestinal decompression after excision and anastomosis of lower digestive tract cannot effectively reduce the gastrointestinal tract pressure and has no obvious effect on prevention from postoperative complications. On the contrary, it may increase the incidence of pharyngolaryngitis and other complications. Therefore, it is more beneficial for the recovery of patients without gastrointestinal decompression.
軟結腸鏡的臨床應用在腸道疾病的診斷及治療上是一大進步，不但能診斷大腸及末端回腸疾病，更重要的是可以用來治療一些經保守治療無效的下消化道內科疾病以及一些外科疾病，如腸息肉、腸扭轉等需外科手術才能治愈的疾病可用軟結腸鏡治療。我們對1987年7月至2001年8月采用軟結腸鏡診治的低位腸梗阻、乙狀結腸扭轉、假性結腸梗阻、下消化道出血、良性腸狹窄及腸道息肉等9 051例需外科處理的疾病加以探討，以提高軟結腸鏡在治療外科疾病中的安全性及療效。