目的 通过对5例小肠急性大出血诊治过程的分析,探讨急诊消化内镜、选择性动脉造影、外科手术紧密协作的临床价值.方法 我院消化内科201 1年1月1日- 2011年12月31日共收治不明原因消化道出血 20例,对其中5例小肠急性大出血病例的救治过程进行分析、总结.结果 5例患者经常规胃镜及结肠镜检查均未见出血性病灶,4例经小肠镜检查发现病变后行手术治疗,其中2例在小肠镜检查过程中再发大出血,经急诊选择性动脉造影栓塞止血后,外科手术成功切除病变；1例大量便血患者经急诊结肠镜和急诊胃镜检查排除上消化道及结肠出血后,因患者失血量较大,无法耐受小肠镜检查,遂行紧急选择性动脉造影明确病变部位及大致性质后行手术治疗.5例小肠急性大出血中2例间质瘤、2例憩室病、1例血管畸形,均救治成功.结论 急诊内镜、选择性动脉造影和外科手术的紧密协作,能够安全有效地救治小肠急性大出血,另外内外科紧密配合是患者得以成功救治的关键.%Objective To analyze and summarize the effect of emergency endoscopy, selective arteriography and surgery in treatment of acute intestinal hemorrhage. Methods From Jan. 2011 to Dec. 2011 , there were 20 cases of acute intestinal hemorrhage treated in department of gastroenterology. The efficacy of diagnosis and treatment of 5 cases of a-cute intestinal hemorrhage were analyzed. Results No hemorrhagic lesion was found in all of the 5 cases through gas-troscope and colonscope, 4 cases were diagnosed by enteroscopy and surgical therapy was followed, 1 case, which couldn ' t tolerate enteroscopey because of large-amount of bleeding after gastroscope and colonscope failed in searching hemorrhage lesions, was diagnosed by emergency arteriography and then surgical therapy was followed. All 5 cases were healed by surgery. Among them, there were 2 stromal tumors, 2 diverticular diseases and 1 vascular malformation. Conclusion Emergency enteroscopy combined with selective arteriography and surgery is effective in both diagnosis and treatment of acute intestinal hemorrhage.
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