小肠出血的诊断方法及病因分析
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摘要
目的探讨小肠出血的诊断方法及病因分析。方法回顾性分析郑州市第一人民医院2011年7月至2017年12月收治的37例小肠出血患者的临床资料。结果各检查方法在小肠出血的检查中阳性率分别为:术中内镜100%,结肠镜11.8%,多层螺旋CT扫描(MSCT)8.8%,数字减影血管造影(DSA)69.2%.胶囊内镜71.4%,气钡双重造影21.4%,小肠镜46.7%。37例小肠出血患者中33例检查结果阳性,其中小肠肿瘤10例(27.0%),血管病变10例(27.0%),炎症性肠病5例(13.5%),憩室7例(18.9%),小肠钩虫1例(2.7%);原因不明4例(10.8%)。结论小肠出血病因多样,检查缺乏特异性,根据出血的缓急可选择合适的检查方法,胶囊内镜、DSA、小肠镜检查的检出率较高。小肠出血肿瘤、血管畸形最为多见。
Objective To discuss diagnosis and etiology of small bowel bleeding.Methods The data of 37 cases of small bowel bleeding from July of 2011 to December of 2017 were retrospectively analyzed.Results Positive rate of diagnostic methods was followed: enteroscope examination during operation 100%, coloscope 11.8%, multislice spiral CT scan(MSCT) 8.8%, digital subtraction angiography(DSA) 69.2%, capsule endoscopy 71.4%, enteroclysis 21.4%, device assisted enteroscopy 46.7%. Among 37 cases of small intestinal bleeding, 33 cases were positive, small bowel tumors were found in 10 cases(27.0%), angiodysplasia in 10 cases(27.0%), inflammatory bowel disease in 5 cases(13.5%), diverticulum in 7 cases(18.9%), small bowel ancylostomiasis in 1 cases(2.7%), and 4 cases with unknown cause(10.8%).Conclusion There are various etiological factors and lack of specificity in small bowel bleeding. Appropriate examination methods can be selected according to the priority of bleeding, and the detection rates of capsule endoscopy, DSA and enteroscopy are higher. Small intestinal bleeding tumors and vascular malformations are most common.
Objective To discuss diagnosis and etiology of small bowel bleeding.Methods The data of 37 cases of small bowel bleeding from July of 2011 to December of 2017 were retrospectively analyzed.Results Positive rate of diagnostic methods was followed: enteroscope examination during operation 100%, coloscope 11.8%, multislice spiral CT scan(MSCT) 8.8%, digital subtraction angiography(DSA) 69.2%, capsule endoscopy 71.4%, enteroclysis 21.4%, device assisted enteroscopy 46.7%. Among 37 cases of small intestinal bleeding, 33 cases were positive, small bowel tumors were found in 10 cases(27.0%), angiodysplasia in 10 cases(27.0%), inflammatory bowel disease in 5 cases(13.5%), diverticulum in 7 cases(18.9%), small bowel ancylostomiasis in 1 cases(2.7%), and 4 cases with unknown cause(10.8%).Conclusion There are various etiological factors and lack of specificity in small bowel bleeding. Appropriate examination methods can be selected according to the priority of bleeding, and the detection rates of capsule endoscopy, DSA and enteroscopy are higher. Small intestinal bleeding tumors and vascular malformations are most common.
引文
[1] PASHA S F, HARA A K, LEIGHTON J A. Diagnostic evaluation and management of obscure gastrointestinal bleeding: a changing paradigm[J]. Gastroenterol Hepatol(N Y), 2009, 5(12): 839-850.
[2] 羊琦, 吴万春. 小肠出血的内镜诊治进展[J]. 国际消化病杂志, 2016 (1): 25-27, 30.
[3] 何磊, 文刚, 涂从银, 等. 术中内镜在隐源性小肠出血中的临床价值[J]. 中华临床医师杂志(电子版), 2012, 6(9): 2514-2515.
[4] SINGH A, MARSHALL C, CHAUDHURI B, et al. Timing of video capsule endoscopy relative to overt obscure GI bleeding: implications from a retrospective study[J]. Gastrointest Endosc, 2013, 77(5): 761-766.
[5] ZUCKERMAN G R, PRAKASH C, ASKIN M P, et al. AGA technical review on the evaluation and management of occult and obscure gastrointestinal bleeding [J]. Gastroenterology, 2000, 118(1): 201-221.
[6] 罗光华, 肖文连, 单鸿, 等. 不明原因小肠出血数字减影血管造影价值[J]. 介入放射学杂志, 2006(4): 221-223.
[7] NIEMENMAA H, M?KEL? T, JUSSILA A, et al. The diagnostic value of video capsule endoscopy [J]. Eur J Intern Med, 2010, 21(5): 383-385.
[8] 仇连峰, 白云, 孙世龙, 等. 不同方法对提高胶囊内镜检查效果的临床研究[J]. 河南医学研究, 2010, 19(4): 453-456.
[9] 温小恒, 钱家鸣, 伍东升, 等. 不同检查方法在小肠出血诊断中的应用[J]. 胃肠病学和肝病学杂志, 2008(6): 441-443.
[10] JEON S R, KIM J O. Deep enteroscopy: which technique will survive?[J]. Clin Endosc, 2013, 46(5): 480-485.
[11] 王延明, 岳海岭, 茆成祥, 等. 小肠出血47例诊治分析[J]. 临床军医杂志, 2015, 43(9): 896-898.
[12] LEWIS B S. Small intestinal bleeding[J]. Gastroenterol Clin North Am, 2000, 29(1): 67-95.
[2] 羊琦, 吴万春. 小肠出血的内镜诊治进展[J]. 国际消化病杂志, 2016 (1): 25-27, 30.
[3] 何磊, 文刚, 涂从银, 等. 术中内镜在隐源性小肠出血中的临床价值[J]. 中华临床医师杂志(电子版), 2012, 6(9): 2514-2515.
[4] SINGH A, MARSHALL C, CHAUDHURI B, et al. Timing of video capsule endoscopy relative to overt obscure GI bleeding: implications from a retrospective study[J]. Gastrointest Endosc, 2013, 77(5): 761-766.
[5] ZUCKERMAN G R, PRAKASH C, ASKIN M P, et al. AGA technical review on the evaluation and management of occult and obscure gastrointestinal bleeding [J]. Gastroenterology, 2000, 118(1): 201-221.
[6] 罗光华, 肖文连, 单鸿, 等. 不明原因小肠出血数字减影血管造影价值[J]. 介入放射学杂志, 2006(4): 221-223.
[7] NIEMENMAA H, M?KEL? T, JUSSILA A, et al. The diagnostic value of video capsule endoscopy [J]. Eur J Intern Med, 2010, 21(5): 383-385.
[8] 仇连峰, 白云, 孙世龙, 等. 不同方法对提高胶囊内镜检查效果的临床研究[J]. 河南医学研究, 2010, 19(4): 453-456.
[9] 温小恒, 钱家鸣, 伍东升, 等. 不同检查方法在小肠出血诊断中的应用[J]. 胃肠病学和肝病学杂志, 2008(6): 441-443.
[10] JEON S R, KIM J O. Deep enteroscopy: which technique will survive?[J]. Clin Endosc, 2013, 46(5): 480-485.
[11] 王延明, 岳海岭, 茆成祥, 等. 小肠出血47例诊治分析[J]. 临床军医杂志, 2015, 43(9): 896-898.
[12] LEWIS B S. Small intestinal bleeding[J]. Gastroenterol Clin North Am, 2000, 29(1): 67-95.