Al-Magedi Ahmed A S, Xv Yifan, Wang Zhi, Xu Wei, Wu Rong, Zhang Weiyu, Tao Qingsong
Departments of General Surgery.
Gastroenterology, Affiliated Zhongda Hospital, School of Medicine, Southeast University, Jiangsu, China.
Surg Laparosc Endosc Percutan Tech. 2023 Feb 1;33(1):37-44. doi: 10.1097/SLE.0000000000001138.
Small bowel (SB) bleeding is one of the common gastrointestinal problems, particularly in elders. The study aimed to find the causes of refractory bleeding and overcome the challenges and difficulties of surgical treatment for SB refractory bleeding.
All patients with SB refractory bleeding who underwent surgical treatment were included in this study. Patients' characteristics, surgical finding, and follow-up assessments were reviewed and analyzed through Hospital Information System records from October 1, 2014, to November 30, 2020. All analyses were performed using SPSS v23.0.
The causes of SB bleeding include vascular lesions (angioectasia, arteriovenous malformations, and dieulafoy lesions) 29.6%, tumors (Polyps, gastrointestinal stromal tumor, Adenocarcinoma, and other) 24.5%, diverticular 18.4%, ulcers/erosion 15.3%, inflammatory bowel disease 7.1%, and other 5.1%. Patients (age below 60 y) were highly developed SB bleeding caused by diverticular 26.4% compared with patients (age 60 y or older) 8.9%, whereas bleeding caused by vascular lesions was significantly higher in patients (age 60 y or older) 37.8%. Other causes, such as tumors and inflammatory bowel disease, showed no significant difference related in age. Exploratory laparotomy was the standard method of bowel extrinsic examination. The intraoperative enteroscopy enterotomy (IOE-E) and IOE-combined were performed in 52 patients (1:1). IOE-E shows lower postoperative morbidity and shorter time of operation P <0.05 compared with the IOE-combined approach.
Age and exhaustive patient history can assist in finding out the etiology. IOE-E is safe, and coordination between surgeon and endoscopist is necessary for IOE if an identifiable source cannot be found in endoscopy or exploratory laparotomy alone.
小肠出血是常见的胃肠道问题之一，在老年人中尤为常见。本研究旨在找出难治性出血的原因，并克服小肠难治性出血外科治疗的挑战与困难。
本研究纳入了所有接受外科治疗的小肠难治性出血患者。通过2014年10月1日至2020年11月30日的医院信息系统记录，对患者的特征、手术发现及随访评估进行回顾和分析。所有分析均使用SPSS v23.0进行。
小肠出血的原因包括血管病变（血管扩张、动静脉畸形和杜氏病损）占29.6%，肿瘤（息肉、胃肠道间质瘤、腺癌等）占24.5%，憩室占18.4%，溃疡/糜烂占15.3%，炎症性肠病占7.1%，其他占5.1%。年龄小于60岁的患者中，憩室导致的小肠出血发生率较高，为26.4%，而60岁及以上患者中该比例为8.9%；血管病变导致的出血在60岁及以上患者中显著更高，为37.8%。其他原因，如肿瘤和炎症性肠病，在年龄方面无显著差异。剖腹探查术是肠道外部检查的标准方法。52例患者（比例为1:1）接受了术中肠镜肠切开术（IOE-E）和联合IOE。与联合IOE方法相比（P<0.05），IOE-E术后发病率更低，手术时间更短。
年龄和详尽的患者病史有助于找出病因。IOE-E是安全的，如果在内镜检查或单独的剖腹探查术中无法找到可识别的出血源，外科医生和内镜医生之间的协作对于IOE是必要的。
