28例小肠出血诊断及病因分析

Diagnosis and etiology of 28 patients with small intestinal bleeding

目的:分析和探讨28例小肠出血的病因、诊断。方法:28例分别行99mTc扫描、选择性血管造影(SA)、剖腹探查加术中肠镜检查,均经手术及病理证实。结果:小肠肿瘤15例(53.6%),以平滑肌瘤多见;血管发育不良、畸形7例(25.0%);毛细血管扩张2例(7.1%);M eckel憩室3例(10.7%);动静脉瘘1例(3.6%)。核素扫描阳性率42.9%(3/7);SA阳性率76.9%(20/26);5例剖腹探查,3例阳性,另2例借助术中肠镜发现病变。结论:小肠肿瘤占出血原因首位,其次为血管发育不良、畸形,SA对小肠出血的诊断有重要价值,原因不明者及时剖腹探查加术中肠镜检查可提高阳性发现。

Objective To investigate the etiology of small intestinal bleeding through the analysis of 28 cases. Methods Twenty-eight cases with small intestinal bleeding were diagnosed by-radionuclide scanning (99mTc), selective angiography, exploratory laparotomy and intra-operative coloscopy,and were confirmed by examination of postoperative pathology. Results Fifteen cases (53.6%) had small intestinal tumors, including 8 with leiomyoma,7(25.0%)with angiodysplasia and deformity, 2(7.1%)with capillarectasia, 3 (10.7%) with Meckel's diverticulum, and 1 (3.6%) with arteriovenous fistula. The radionuclide scanning showed positive results in 3 out of 7 cases. The angiography was performed in 26 cases and 20 of them were abnormal. The exploratory laparotomy was performed in 5 cases, 3 of whom had lesions and the other two were diagnosed by intra-operative coloscopy. Conclusions Tumor is the most common cause of small intestinal bleeding. Angiodysplasia and deformity are also commonly seen (25.0%). Angiography is valuable for diagnosis.The exploratory laparotomy is necessary for repeated small intestinal bleeding with obscure origin and the intra-operative coloscopy is helpful.