Al Qahtani Aayad R, Satin Richard, Stern Jerry, Gordon Philip H
Division of Colorectal Surgery, Department of Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, 3755 Cote Ste. Catherine Road, Montreal, Quebec H3T 1E2, Canada.
World J Surg. 2002 May;26(5):620-5. doi: 10.1007/s00268-001-0279-x. Epub 2002 Mar 1.
The objective of this study was to evaluate the efficacy of various diagnostic modalities in the assessment of patients with massive lower gastrointestinal bleeding. The charts of all patients admitted to a McGill University affiliated teaching hospital with the diagnosis of lower gastrointestinal bleeding over a 25-year period were reviewed. There were 136 patients who underwent 202 admissions. The information documented included demographics on age, gender, co-morbid disease, prescribed medications, requirements for blood transfusions, orthostatic change in blood pressure, acute drop in hematocrit (to <30%), and exclusion of upper gastrointestinal bleeding. Among the 202 admitted patients there were 116 men and 86 women), with an average age of 70 years (range 16-95 years). At least one significant medical disease was found in 93% of these patients; and 20% were on aspirin and 5% on anticoagulants at the time of diagnosis. Rigid or flexible sigmoidoscopy was performed in 68 and 18 patients, respectively, with a definitive diagnosis made in 2.9% and 11.0%, respectively. Colonoscopy was performed in 152 cases, 20 of which were incomplete; a specific diagnosis was made for 59 admissions (45%). A red blood cell or colloid scan was performed on 53 patients, with extravasation noted in 13 (24.5%); a localized site of bleeding was identified in 9 cases (17%). Angiography was performed on 31 patients with bleeding sites localized in 6 (19%). Barium enemas were completed in 85 of 92 patients, and the presumptive cause of bleeding was identified in 72% of those with a complete examination. The most common causes identified were diverticulosis in 52 patients and angiodysplasia in 14. The cause of bleeding was not detected in 48 (35%). Bleeding stopped in most patients spontaneously, with only 7 requiring operation. The average number of units transfused was 3 (range 0-26). Scintigraphy and angiography were less efficacious than colonoscopy for localizing the site and etiology of the bleeding. Despite the combination of investigative modalities, a definitive diagnosis was not made in 35% of the admitted patients. The need for operative intervention in our study was lower than in most previous reports.
本研究的目的是评估各种诊断方法在评估大量下消化道出血患者中的疗效。回顾了麦吉尔大学附属教学医院25年间收治的所有诊断为下消化道出血患者的病历。共有136例患者接受了202次住院治疗。记录的信息包括年龄、性别、合并疾病、处方药物、输血需求、血压的体位性变化、血细胞比容急剧下降（至<30%）以及排除上消化道出血。在202例住院患者中，男性116例，女性86例，平均年龄70岁（范围16 - 95岁）。这些患者中93%至少有一种严重的内科疾病；诊断时20%的患者正在服用阿司匹林，5%的患者正在服用抗凝剂。分别对68例和18例患者进行了硬式或软式乙状结肠镜检查，确诊率分别为2.9%和11.0%。对152例患者进行了结肠镜检查，其中20例未完成；59例住院患者（45%）做出了明确诊断。对53例患者进行了红细胞或胶体扫描，13例（24.5%）发现有造影剂外渗；9例（17%）确定了出血的局部部位。对31例患者进行了血管造影，6例（19%）确定了出血部位。92例患者中的85例完成了钡灌肠，72%完成检查的患者确定了出血的推测原因。确定的最常见原因是52例憩室病和14例血管发育异常。48例（35%）未检测到出血原因。大多数患者的出血自行停止，只有7例需要手术。平均输血量为3个单位（范围0 - 26）。闪烁扫描和血管造影在确定出血部位和病因方面不如结肠镜检查有效。尽管采用了多种检查方法，但35%的住院患者仍未做出明确诊断。我们研究中手术干预的需求低于大多数先前的报告。
