Analysis Of Etiology And Surgical Treatment Of Small Intestinal Bleeding

Objective To discuss about the etiology of small intestinal bleeding,and analyse surgical treatments of small intestinal bleeding,to sum up the experiences of clinicalapplication.Methods A retrospective study of clinical data of 85 patients with small intestinal bleedingat the general surgery and digestive department of 2nd Affiliated Hospital of Soochow University from December 2008 to December 2015,and 74 patientunderwent surgical treatment from these 85 patients.The causes of small intestinal bleeding were analyzedretrospectively and the application value of different surgical treatments to small intestinal bleeding were compared.Results Tumors accounted for 44.71% of the patients with small intestinal bleeding, followed by inflammation(22.35%),diverticulum(16.47%),vascular disease(12.94%),intussusception(2.35%) and hookworm(1.18%).The most site of small intestinal bleeding was only located inileum(54.12%),followed by only located in jejunum(54.12%) and located in both jejunum and ileum(8.23%).Interstitialoma accounted for 57.89% of the histopathological types of tumors which lead to small intestinal bleeding, followed by adenocarcinoma(21.05%),lymphoma(7.90%),neuroendocrine neoplasm(5.26%),leiomyoma(2.63%),adenoma(2.63%) and Sarcoma cancer(2.63%).High risk of interstitialoma accounted for 77.27% of all types of interstitialoma,followed by low risk(13.64%) and intermediate(9.09%).The types of mall intestinal bleeding were chronic overt bleeding(45.88%),chronic recessive bleeding(38.82%) and acute massive bleeding(15.29%).The types of surgery including partial enterectomy(94.36%), reduction of intussusception(2.82%), mass biopsy(1.41%), diverticulum varus suture technique(1.41%). The general good rate of surgical treatments was 93.24%,the good rate of open surgery was 92.73%,compared with laparoscopic surgery(94.74%),no significantdifference(P>0.05).Compared with opensurgery,the incidence rate of postoperative complications and recurrence rate of postoperative bleeding were identical of laparoscopic surgery,no significantdifference(P>0.05).And the indicators including mean operative time,intraoperative blood loss, visual analogue assessment score of the first day after surgery,mean postoperative feeding time and mean postoperative hospital stay of laparoscopic surgery were better than open surgery,significantdifferences(P<0.05).Conclusion Tumors,inflammation,diverticulum and vascular disease were the common causes of small intestinal bleeding.Interstitialoma and adenocarcinoma were the common histopathological types of tumors which lead to small intestinal bleeding.The high risk of interstitialoma has the biggest risk of bleeding.The most common type of mall intestinal bleeding was chronic overt bleeding,followed by chronic recessive bleeding,the elective surgery can be the first choice for these two types.The first choice of acute massive bleeding was emergency operation,and open surgery was the first choice of emergency operation.The laparoscopic surgery was safe and effective,has obvious minimally invasive effect,it was the important means of diagnosis and treatment for mall intestinal bleeding.In conditional areas and hospitals, the laparoscopic surgery can be the choice for patients with small intestinal bleeding whichunderwentelective operations.