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目的探讨由肠道血管畸形形成所致的下消化道出血的诊断和治疗方法。方法对13例常规检查未能明确诊断而经肠道血管照影诊断为肠道血管畸形并经手术病理证实的病例行回顾性分析。结果(1)13例病例具有相类似的临床症:反复发作的可自行停止的柏油样或暗红色便及相应的缺铁性贫血性症状;(2)均为中老年患者;(3)血管造影所示血管畸形好发于回盲部及升结肠,其次为空肠、回肠及乙状结肠;大多数为单发,少数为多发;(4)行右半结肠切除righthemicolon resection6例,右半结肠及部分空肠切除2例,回肠及空肠部分切除2例,回盲部分切除2例,回肠部分及乙状结肠切除1例。随访:8例痊愈。3例仍有间歇性便血,但症状明显减轻,内科保守治疗。2例死于心脏病。结论(1)肠道血管畸形是导致老年人下消化道出血重要原因之一;(2)由于临床症状无特征性,病变细微及诊断手段局限,本病易被误诊及漏诊;(3)选择性肠系膜血管造影是目前诊断本病的最佳方法(非出血期,可见异常血管,出血期间可见造影剂外溢);(4)外科手术为本病治疗的首选,术前、术中定位准确是确保手术彻底性的关键。
Objective To investigate the diagnosis and treatment of lower gastrointestinal bleeding caused by the formation of intestinal vascular malformations. Methods Retrospective analysis of 13 cases of routine examination failed to confirm the diagnosis of intestinal vascular angiography diagnosed as intestinal vascular malformations confirmed by surgery and pathology. Results (1) Thirteen patients had similar clinical symptoms: recurrent self-stopping tarry or dark red stools and corresponding iron deficiency anemia; (2) both middle-aged and elderly patients; (3) blood vessels Angiography showed vascular malformations occur in the ileocecal and ascending colon, followed by the jejunum, ileum and sigmoid colon; most of the single hair, a few are multiple; (4) right colon resection righthemicolon resection6 cases, right colon and part Jejunum resection in 2 cases, ileum and jejunum partial resection in 2 cases, ileocecal partial resection in 2 cases, ileum and sigmoid resection in 1 case. Follow-up: 8 patients recovered. 3 cases still intermittent blood in the stool, but the symptoms were significantly reduced, conservative treatment of internal medicine. 2 died of heart disease. Conclusions (1) Intestinal vascular malformations are one of the most important causes of lower gastrointestinal bleeding in the elderly. (2) The disease is easily misdiagnosed and misdiagnosed due to the lack of clinical features, subtle pathological changes and diagnostic methods. (3) Mesenteric angiography is the best method for the diagnosis of this disease (non-bleeding, abnormal blood vessels can be seen during the bleed, contrast agent can be seen during the spill); (4) Surgical operation is the preferred treatment of this disease, preoperative and intraoperative positioning accuracy The key to ensuring the thoroughness of the surgery.