目的 探讨Abernethy畸形致下消化道出血的诊断及治疗方法。方法 回顾1例Abernethy畸形患者的诊治情况，并结合相关文献进行分析。结果 血管造影确诊后经积极术前准备，行剖腹探查、乙状结肠造瘘术，术后3周开始给予中药保留灌肠至术后7周，6个月关闭造瘘,3周后继续辅以中药保留灌肠4周。患者顺利恢复出院，随访9个月未再次出血。结论 正确的诊断及合理的治疗方案是救治的关键。
【Abstract】Objective To discuss the clinical significance of postoperative application of gastrointestinal decompression after anastomosis of lower digestive tract. Methods Three hundred and sixty-eight patients undergoing excision and anastomosis of lower digestive tract were divided into two groups: the group with postoperative gastrointestinal decompression and the group without it. The clinical therapeutic outcomes and incidences of complications were compared between the two groups. Results The volume of gastric juice in the decompression group was about 200 ml every day after operation. Both groups had a smaller abdomenal circumference before operation than after operation （P＜0.001）. No difference in the time of first passage of gas from anus and defecation after operation was found between the two groups. The incidence of complications in the decompression group was obviously higher than that of non-decompression group (28.0% vs. 8.2%, P＜0.001); the incidence of pharyngolaryngitis of the former was up to 23.1%. There was also no difference found between these two groups regarding the hospital stay after operation.Conclusion The present study shows that application of gastrointestinal decompression after excision and anastomosis of lower digestive tract cannot effectively reduce the gastrointestinal tract pressure and has no obvious effect on prevention from postoperative complications. On the contrary, it may increase the incidence of pharyngolaryngitis and other complications. Therefore, it is more beneficial for the recovery of patients without gastrointestinal decompression.
软结肠镜的临床应用在肠道疾病的诊断及治疗上是一大进步，不但能诊断大肠及末端回肠疾病，更重要的是可以用来治疗一些经保守治疗无效的下消化道内科疾病以及一些外科疾病，如肠息肉、肠扭转等需外科手术才能治愈的疾病可用软结肠镜治疗。我们对1987年7月至2001年8月采用软结肠镜诊治的低位肠梗阻、乙状结肠扭转、假性结肠梗阻、下消化道出血、良性肠狭窄及肠道息肉等9 051例需外科处理的疾病加以探讨，以提高软结肠镜在治疗外科疾病中的安全性及疗效。
目的：探讨DSA诊断小肠血管畸形的价值。方法：本文分析21例小肠血管畸形患者的临床及DSA特征，其中男性14例，女性7例，所有患者均行肠系膜上、下动脉造影。结果：临床特征：①急性消化道出血为主症状；②常规检查一般为阴性；③血红蛋白含量短期内降至4～6 g/mL。DSA特征：①动静脉瘘；②局部肠壁染色增浓；③局部血管异常增多，结构紊乱。其中12例进行了动脉导丝栓塞，2例栓塞后出血，进行外科手术切除。结论：DSA是诊断血管畸形所致小肠出血的最有效的方法，动脉导丝栓塞是安全，有效的治疗方法，同时为外科手术切除提供的正确部位。
【Abstract】 Objective To evaluate the detection and localization of obscure lower gastrointestinal bleeding by using SPECT/CT and intraoperative endoscopy. Methods Twenty-six cases of patients with obscure lower gastrointestinal bleeding were analyzed retrospectively. Results The positive detection rate of SPECT/CT was 88.5%. All 26 patients (100%) were identified the bleeding source by using intraoperative endoscopy. No recurrence was found during 1-24 months follow-up. Conclusion SPECT/CT examination should be chosen firstly for patients with obscure lower gastrointestinal bleeding in order to localize the bleeding site roughly. Intraoperative endoscopy can localize the bleeding site accurately in patients who undergoes operation.