Parry M M, Krige J E, Harries-Jones E P
Department of Surgery, University of Cape Town, Observatory, RSA.
S Afr Med J. 1987 Dec 5;72(11):762-6.
Thirty-four patients with major lower intestinal bleeding underwent emergency selective mesenteric angiography during a 6-year period. Angiography identified a bleeding site in 16 patients (47%). Diverticulosis, found in 22 patients (65%), and angiodysplasia, found in 4 (12%), were the most common causes of major colonic bleeding and originated more frequently from the right colon. Eight patients (24%) bled from less common sources. Radiological control of bleeding was unreliable with a significant complication rate. Fourteen of 16 patients with positive angiograms and 6 of 18 patients with negative angiograms required surgery for persistent major bleeding. Angiographic localisation of colonic bleeding allowed limited resection in 9 of 11 patients with control of haemorrhage in 8 (89%). Fourteen of 34 patients were managed non-operatively; of these 2 had minor recurrent bleeding. The overall mortality rate was 29%, the operative mortality rate 40% and the non-operative mortality rate 14%. A rational diagnostic approach is presented, emphasising the role of selective mesenteric angiography in the management and surgical strategy of major lower intestinal bleeding.
在6年期间，34例严重下消化道出血患者接受了急诊选择性肠系膜血管造影。血管造影在16例患者（47%）中发现了出血部位。憩室病在22例患者（65%）中被发现，血管发育异常在4例患者（12%）中被发现，它们是主要结肠出血的最常见原因，且更常起源于右半结肠。8例患者（24%）出血来自较罕见的部位。出血的放射学控制不可靠，并发症发生率较高。16例血管造影阳性的患者中有14例，18例血管造影阴性的患者中有6例因持续性大出血需要手术。结肠出血的血管造影定位使11例患者中的9例能够进行有限切除，其中8例（89%）出血得到控制。34例患者中有14例接受了非手术治疗；其中2例有轻微复发性出血。总体死亡率为29%，手术死亡率为40%，非手术死亡率为14%。本文提出了一种合理的诊断方法，强调了选择性肠系膜血管造影在严重下消化道出血的管理和手术策略中的作用。
