Department of Surgery, Washington Hospital Center, Washington, District of Columbia, USA.
J Surg Res. 2012 Oct;177(2):315-9. doi: 10.1016/j.jss.2012.05.026. Epub 2012 May 26.
Although indications for surgery in lower gastrointestinal bleeding (LGIB) are widely described, practice varies. This study was designed to assess outcomes of patients allowed to exceed traditional triggers for surgery because of LGIB.
This is a retrospective review of patients at an urban tertiary hospital over a 3-y period that had LGIB necessitating (99m)Tc-labeled red blood cell scintigraphy. Traditional indications for operative treatment of LGIB were defined as transfusion of >6U of packed red blood cells, hemodynamic instability, bleeding lasting >72h, and rebleeding after cessation of bleeding for >24h.
One hundred ninety-four LGIB patients had scintigraphy during the period of study with 180 meeting inclusion criteria. Fifty-six (31%) patients had at least one operative indication, and 32 (60%) were managed nonoperatively without a mortality. There were two (8.3%) mortalities in those who had operative management, one of which was because of exsanguination. Eighteen (32%) patients who met operative criteria were unlocalized.
Patients with LGIB can be safely managed nonoperatively, even when the bleed is unlocalized and traditional indications for surgery are met. Exsanguinations because of LGIB treated nonoperatively are rare except in patients deemed not to be surgical candidates.
尽管下消化道出血（LGIB）的手术适应证已有广泛描述，但实践中存在差异。本研究旨在评估因 LGIB 而允许超过传统手术触发因素的患者的结局。
这是对一家城市三级医院 3 年内因 LGIB 需要进行 99mTc 标记红细胞闪烁扫描的患者进行的回顾性研究。LGIB 手术治疗的传统适应证定义为输注>6U 浓缩红细胞、血流动力学不稳定、出血持续>72h 和出血停止后>24h 再出血。
在研究期间，194 例 LGIB 患者进行了闪烁扫描，其中 180 例符合纳入标准。56 例（31%）患者至少有一个手术适应证，32 例（60%）患者非手术治疗无死亡。在接受手术治疗的患者中有 2 例（8.3%）死亡，其中 1 例因出血性休克。符合手术标准的 18 例（32%）患者未定位。
LGIB 患者即使出现未定位出血且符合手术适应证，也可以安全地进行非手术治疗。除非被认为不适合手术，否则因 LGIB 而接受非手术治疗的失血性休克极为罕见。
