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小肠出血

Small Bowel Bleeding.

作者信息

Kovacs Thomas O G

机构信息

Division of Digestive Diseases, CURE Digestive Diseases Research Center, David Geffen UCLA School of Medicine, Building 115, Room 212, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA.

出版信息

Curr Treat Options Gastroenterol. 2005 Feb;8(1):31-38. doi: 10.1007/s11938-005-0049-1.

Abstract

The management of patients with small bowel bleeding remains a diagnostic and therapeutic challenge. In most gastrointestinal bleeding episodes, the source of hemorrhage is localized to either the upper gastrointestinal tract or colon; however, in about 5% of cases, upper endoscopy and colonoscopy are nondiagnostic, and the small intestine is the site of bleeding. Patients with suspected small bowel source of bleeding may present with either occult blood loss or recurrent overt gastrointestinal hemorrhage requiring frequent blood transfusions and hospitalizations. Knowing the etiology and site of hemorrhage is essential prior to initiating appropriate therapy. The most common causes of small bowel bleeding are vascular ectasia, tumors, ulcerative diseases, and Meckel's diverticula. For patients with severe obscure bleeding, push enteroscopy with a 220- to 250-cm enteroscope is strongly recommended. This procedure provides not only a thorough examination for diagnosis, but also allows for biopsy, tattooing, and hemostasis of lesions. If enteroscopy is nondiagnostic, capsule endoscopy is recommended. A diagnostic capsule endoscopy will direct appropriate medical, endoscopic, or surgical intervention, depending on whether the lesion is single or multiple, and whether the patient is a surgical candidate for intraoperative enteroscopy. Intraoperative enteroscopy should be strongly considered in patients with recurrent bleeding and a nondiagnostic evaluation. Laparoscopy and intraoperative enteroscopy is highly recommended in young patients (< 50 years of age) because there is an increased frequency of small bowel tumors and Meckel's diverticulum which are amenable to surgical therapy.

摘要

小肠出血患者的管理仍然是一项诊断和治疗挑战。在大多数胃肠道出血病例中,出血源局限于上消化道或结肠;然而,在约5%的病例中,上消化道内镜检查和结肠镜检查无法明确诊断,小肠是出血部位。疑似小肠出血源的患者可能表现为隐匿性失血或反复明显的胃肠道出血,需要频繁输血和住院治疗。在开始适当治疗之前,了解出血的病因和部位至关重要。小肠出血最常见的原因是血管扩张、肿瘤、溃疡性疾病和梅克尔憩室。对于严重不明原因出血的患者,强烈建议使用220至250厘米的小肠镜进行推进式小肠镜检查。该操作不仅能进行全面的诊断检查,还能对病变进行活检、标记和止血。如果小肠镜检查无法明确诊断,则建议进行胶囊内镜检查。诊断性胶囊内镜检查将根据病变是单发还是多发以及患者是否适合术中小肠镜检查的手术候选者情况,指导适当的药物、内镜或手术干预。对于反复出血且评估未明确诊断的患者,应强烈考虑术中小肠镜检查。对于年轻患者(<50岁),强烈建议进行腹腔镜检查和术中小肠镜检查,因为小肠肿瘤和梅克尔憩室的发生率增加,适合手术治疗。

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