Bar A H, DeLaurentis D A, Parry C E, Keohane R B
Surg Gynecol Obstet. 1980 Feb;150(2):226-8.
Initial stabilization of blood volume and immediate resuscitative measures should be used for lower gastrointestinal tract bleeding. Upper gastrointestinal tract lesions should be excluded with nasogastric intubation and upper endoscopy if the history or nasogastric aspirate suggests an upper gastrointestinal tract source. Proctosigmoidoscopy should be done to exclude mucosal disease, hemorrhoidal bleeding or local carcinoma. If all of these are negative and the patient is bleeding massively, we recommend arteriography with catheterization of the superior mesenteric, inferior mesenteric and celiac arteries. These procedures should be carried out within less than four hours. If a bleeding site is demonstrated, the use of local infusion of vasopressin for permanent control should be considered only in the poor risk patient in whom the operative risk is prohibitive. Massive hemorrhage from the lower gastrointestinal tract in an elderly population is usually due to diverticular bleeding and not to angiodysplasia. The bleeding site was more common in the right than in the left colon. Angiography has been proved to be an important diagnostic procedure to localize the site of the bleeding and has been invaluable in the surgical management of these patients.
对于下消化道出血，应首先进行血容量的初步稳定及立即的复苏措施。如果病史或鼻胃管抽吸提示上消化道来源，应通过鼻胃管插管和上消化道内镜检查排除上消化道病变。应进行直肠乙状结肠镜检查以排除黏膜疾病、痔疮出血或局部癌。如果所有这些检查均为阴性且患者出血量大，我们建议对肠系膜上动脉、肠系膜下动脉和腹腔动脉进行动脉造影及导管插入术。这些操作应在4小时内完成。如果显示出出血部位，仅在手术风险过高的高危患者中考虑使用局部注射血管加压素进行永久性控制。老年人群下消化道大出血通常是由于憩室出血而非血管发育异常。出血部位在右半结肠比左半结肠更常见。动脉造影已被证明是定位出血部位的重要诊断方法，在这些患者的手术治疗中具有重要价值。
