Birkett D H
Boston University School of Medicine, Massachusetts.
Surg Clin North Am. 1991 Dec;71(6):1259-69. doi: 10.1016/s0039-6109(16)45589-1.
An accurate diagnosis is the prerequisite in defining gastrointestinal tract bleeding at any level. Flexible endoscopy is the mainstay of diagnosis, and, particularly in the colon, it may be used as a therapeutic tool in conjunction with fulguration. Radionuclide scanning and arteriography have a place in diagnosis when endoscopy fails. The management of variceal bleeding is, in the main, injection sclerotherapy, operation being reserved for patients who rebleed after injection sclerotherapy or in whom a long-term course of sclerotherapy fails. The management of patients with colonic bleeding depends on the accurate pinpointing of bleeding before operation followed by limited excision of the located bleeding site. Some sources of lower gastrointestinal-tract bleeding can be treated by therapeutic endoscopy.
准确诊断是明确任何部位胃肠道出血的前提。柔性内镜检查是诊断的主要手段，尤其是在结肠，它可与电凝术联合用作治疗工具。当内镜检查失败时，放射性核素扫描和动脉造影在诊断中具有一席之地。静脉曲张出血的治疗主要是注射硬化疗法，手术仅适用于注射硬化疗法后再出血的患者或长期硬化疗法失败的患者。结肠出血患者的治疗取决于术前准确确定出血部位，然后对定位的出血部位进行有限切除。一些下消化道出血的病因可通过治疗性内镜检查进行治疗。
