从小肠出血的诊断探讨消化道的分段

Exploring segments of digestive tract from diagnosis of enteric hemorrhage

目的:探讨消化道的分段。方法:对34例手术及病理证实的小肠出血行选择性肠系膜动脉造影、核素扫描、小肠气钡双重造影、小肠镜、剖腹探查及术中内镜检查。结果:诊断阳性率为:选择性肠系膜动脉造影62.5％(10/16),核素扫描50.0％(4/8),小肠气钡双重造影42.9％(6/14),小肠镜0.0％(0/4),剖腹探查100.0％(10/10)。结论:小肠出血的诊断首选选择性肠系膜动脉造影;再行核素扫描,尤其是少量小肠出血对核素扫描较敏感;小肠气钡双重造影对小肠微小的隆起和凹陷性病变诊断价值较高;小肠镜的技术有待进一步提高;剖腹探查用于上述辅助检查均未能明确,且排除了上消化道和大肠病变而又有大量出血和反复出血者。应将小肠认为是中消化道而大肠是下消化道。

Objective: To explore the segments of digestive tract. Methods:Selective mesenteric angiogra-phy, radionuclide scanning, double intestinal air-barium contrast examination, enteroscope, exploratory laparotomy and intraoperative colonoscopy were performed in 34 patients with enteric hemorrhage confirmed by surgery and pathology. Results: The positive rate of angiography, radionuclide scanning, double intestinal air-barium contrast examination, enteroscope, exploratory laparotomy and intraoperative colonoscopy was 62. 5% (10/16), 50. 0% (4/ 8), 42. 9% (6/14), 0.0% (0/14), 100. 0% (10/10), respectively. Conclusion: Angiography is the first choice for the diagnosis of enteric hemorrhage, then the radionuclide scanning and enteric hemorrhage are particularly sensitive to the radionuclide scanning. Double intestinal air-barium contrast examination has relatively higher diagnostic value in patients with small prominence or pitting of small intestine. The technique of enteroscope has to be improved. If the diagnosis cannot be decided with the above methods, and upper digestive tract bleeding and large intestine lesion have been excluded, and the patients still have massive bleeding and recurrent bleeding, exploratory laparotomy should be undertaken. Then small intestine should be considered as middle alimentary tract and the large intestine as lower one.