Диагностика дивертикулярных толстокишечных кровотечений (обзор литературы)

ЦЕЛЬ: провести анализ опубликованных данных по диагностике дивертикулярных толстокишечных кровотечений и обосновать выбор эффективной тактики клинического обследования больных с данной патологией.

МАТЕРИАЛЫ И МЕТОДЫ: осуществлен систематический поиск литературы по электронным базам данных eLibrary.ru, PubMed и Cochrane Library за период с 2005 по 2025 гг. Для сбора опубликованных данных использовались поисковые запросы — colonic bleeding OR colonic diverticular bleeding AND colonoscopy AND contrast-enhanced computed tomography AND arteriography AND transabdominal ultrasound AND technetium-99mtagged red blood cell scanning. Первично было найдено 832 публикации. После скрининга и оценки резюме с последующим изучением полных текстов статей было отобрано 66 статей, среди них — 4 метаанализа, 5 обзоров, 34 клинических исследования, 5 клинических рекомендаций. Данная статья подготовлена в соответствии со стандартами PRISMA.

РЕЗУЛЬТАТЫ: за последние 20 лет в структуре гастроинтестинальных кровотечений значительно увеличилась частота толстокишечных дивертикулярных кровотечений. В настоящее время в качестве основного метода диагностики толстокишечных дивертикулярных кровотечений рекомендуется выполнение ранней колоноскопии с использованием стандартных растворов для орального лаважа, эндоскопического колпачка и водоструйного ирригатора. Компьютерная томография с контрастным усилением может быть выбрана начальным диагностическим методом обследования в случаях, когда качественная экстренная колоноскопия не может быть выполнена, а также при неэффективности эндоскопического гемостаза, когда обсуждается возможное применение транскатетерной артериальной эмболизации или выполнение хирургического вмешательства. Применение селективной ангиографии оправдано при продолжающемся массивном или длительном рецидивирующем дивертикулярном толстокишечном кровотечении, когда с помощью колоноскопии не удается определить место кровотечения.

ЗАКЛЮЧЕНИЕ: персонализированный выбор диагностической программы обследования при толстокишечных кровотечениях должен быть основан на объективной оценке тяжести состояния больных, использовании современных вариантов эндоскопической и лучевой визуализации, позволяющих выявить причины кровотечения, установить точную локализацию источника и, в условиях многопрофильного стационара, выполнить необходимое высокотехнологичное лечение.

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