不同检查方法在小肠出血诊断中的应用

The application of different diagnosis methods in small intestinal bleeding

目的探讨不同检查方法在不同小肠出血方式诊断中的应用。方法回顾性分析2000年1月～2007年6月收治的77例小肠出血病例,01～03年为A组与04～07年为B组,比较不同时间以及不同的检查方法对各种类型的小肠出血确诊率以及评估应用价值。结果男∶女为1.57∶1,平均年龄(48.18±20.53)岁。B组小肠出血的诊断率明显高于A组,71.1%(32/45)vs40.6%(13/32)。各种检查方法对小肠出血的确诊率依次为小肠镜诊断率最高,为70%(14/20);胶囊内镜为53.8%(7/13);血管造影41.0%(9/22);小肠核素26.7%(8/30);小肠气钡12.2%(5/41)。本组胶囊内镜诊断显性出血高于隐性出血(5/5vs1/3),小肠镜检出病例为急性大出血和慢性显性出血共14例高于胶囊内镜(7例)和其他检查的总和(11例)。结论胶囊内镜与双气囊小肠镜应用提高了小肠出血的确诊率,把握检查时机(活动性出血期)进行检查可明显提高小肠出血的确诊率。所以根据小肠出血方式选择相应的检查方法,才能既经济、迅速且提高小肠出血病灶的检出率。

Objective To evaluate the role of distinct diagnostic methods in the heterogeneous small intestinal bleeding styles. Methods Seventy-seven consecutive patients from 2000. 1 to 2007. 6, 32 before 2003 （group A） and 45 after 2003 （group B）. The yield of the various diagnostic methods were analysed. Results The males： females ratio was 1.57： 1, and the mean age （48.18±20.53） years. The diagnosis yield was 40.6% （13/32） in group A, and 71.1% （32/45） in group B. The diagnosis yield of douhle-hallon endoscopy was 70% （ 14/20）, capsule endoscopy 53.8% （7/ 13）, angiography 41.0% （9/22）, red cell nuclide scanning 26.7% （8/30）, and barium-air contracst radiography 12.2% （5/41）, respectively. Fourteen acute massive bleeding and overt bleeding were diagnosed by douhle-hallon endoscopy, more than 7 by capsule endoscopy and 11 by other methods. Conclusion With the application of capsule en- doscopy and double-balloon endoscopy, the diagnostic yield of the small intestinal bleeding was greatly improved, especially in the active bleeding. So, according to different bleeding styles, corresponding diagnostic methods should he effective-economic options in the diagnosis of small intestinal bleeding.