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目的探讨小肠肿瘤出血的诊断和手术治疗及预后。方法回顾1990-2010年收治的11例患者资料,根据不同病情,比较不同的检查方法如胃镜、结肠镜、小肠气钡双重造影、数字减影肠系膜动脉造影、剖腹探查、术中内镜检查、全消化道钡餐及螺旋CT血管造影检查、超声在诊断技术中应用情况,分析确定诊断比例及病程与预后关系。结果全消化道造影、内窥镜、肠系膜上动脉造影是诊断和定位小肠肿瘤的主要手段。术中内镜检查和剖腹探查对于小肠肿瘤早期病灶定位诊断成功率高,恶性小肠肿瘤病程长短与预后相关。统计学分析有显著性意义。结论除非有明确的小肠肿瘤病灶,术中内镜检查和剖腹探查是发现小肠肿瘤出血病灶的最佳方法。小肠肿瘤出血治疗应首选手术切除,手术方案、手术方式一般依据肿瘤性质及明确的病变部位来决定。对高度怀疑小肠肿瘤的患者及早剖腹探查可改善预后;对体质弱、严重营养不良患者要采用个体化治疗策略,规避手术风险。
Objective To investigate the diagnosis, surgical treatment and prognosis of intestinal tumor hemorrhage. Methods The data of 11 patients admitted from 1990 to 2010 were retrospectively analyzed. According to the different conditions, different methods such as gastroscopy, colonoscopy, double contrast barium gas imaging, digital subtraction mesenteric artery angiography, laparotomy, intraoperative endoscopy, Total digestive tract barium meal and spiral CT angiography, ultrasound in the application of diagnostic techniques to determine the diagnostic ratio and duration of disease and prognosis. Results Total gastrointestinal angiography, endoscopy, superior mesenteric artery angiography is the main means of diagnosis and localization of small bowel tumors. Intraoperative endoscopy and laparotomy for the early diagnosis of small bowel tumor localization success rate is high, the duration of malignant intestinal tumor associated with prognosis. Statistical analysis has significant significance. Conclusion Unless there is a definite lesion of small intestine, intraoperative endoscopy and laparotomy are the best methods to find the hemorrhage of small intestine tumor. Intestinal tumor bleeding should be the preferred surgical resection, surgical options, surgical methods generally based on the nature of the tumor and a clear location of the lesion to decide. Patients with high suspicion of small bowel cancer can improve their prognosis by laparotomy as early as possible. Individual patients with weak constitution and severe malnutrition should adopt individualized treatment strategies to avoid surgical risk.