Richardson J D, Max M H, Flint L M, Schweisinger W, Howard M, Aust J B
Surgery. 1978 Sep;84(3):430-6.
Thirty-nine patients with bleeding vascular malformations were evaluated. The age range was from 3 to 78 years, with a bimodal age distribution. The younger patients had no associated diseases, while those in the older category invariably had an associated cardiac lesion (aortic stenosis in 12 patients and severe atherosclerotic disease in 11 patients). With experience, colonoscopy has become a valuable adjunct to arteriography with the lesion visualized in 12 patients. Arteriography is the most useful study being diagnostic in 35 of 38 cases. Exploration alone was diagnostic in only one of 39 patients. The most common site of bleeding was the cecum (21 patients) followed by the proximal small intestine (eight patients), terminal ileum (seven patients), and ascending colon (five patients). The lesions in the proximal small bowel were much more common in the younger patients and were believed to be congenital. Resection controlled the bleeding in the majority of patients, although four recurrences have been noted. All have been documented angiographically to have been from a new lesion and two were controlled with reoperation. The key elements to control of these patient's bleeding include: (1) systematic work-up with a team approach emphasizing careful visceral angiography, and (2) the avoidance of a premature laparotomy prior to complete evaluation.
对39例出血性血管畸形患者进行了评估。年龄范围为3至78岁，呈双峰年龄分布。年轻患者无相关疾病，而老年患者均伴有心脏病变（12例主动脉狭窄，11例严重动脉粥样硬化疾病）。随着经验的积累，结肠镜检查已成为血管造影的重要辅助手段，12例患者可见病变。血管造影是最有用的检查方法，38例中有35例诊断明确。仅通过探查确诊的患者在39例中仅1例。最常见的出血部位是盲肠（21例），其次是近端小肠（8例）、回肠末端（7例）和升结肠（5例）。近端小肠的病变在年轻患者中更为常见，被认为是先天性的。大多数患者通过切除控制了出血，尽管有4例复发。所有复发经血管造影证实均来自新病变，2例通过再次手术得到控制。控制这些患者出血的关键因素包括：（1）采用团队方法进行系统检查，强调仔细的内脏血管造影；（2）在完成全面评估之前避免过早进行剖腹手术。
