小肠出血诊断分析(附30例报告)

Diagnosis of bleeding of the small intestine:report of 30 cases

目的探讨小肠出血的诊断方法。方法对30例病理证实的小肠出血术前行小肠气钡造影、核素显像、血管造影、剖腹探查和术中肠镜检查。结果阳性率为:气钡造影46.2%(6/13)、核素显像87.5%(14/16)、血管造影66.7%(10/15)。定位符合率为:气钡造影66.7%(4/6)、核素显像42.9%(6/14)、血管造影90.0%(9/10)。出血期术前检查阳性率90.0%(18/20)、间歇期为44.4%(4/9),7例阴性和1例大出血危及生命者行剖腹探查确诊。结论小肠出血的诊断程序为在活动性出血而不伴严重休克者宜首选核素显像,再行血管造影;仍未明确而有手术指征者行剖腹探查,必要时结合术中肠镜;间歇期者先行气钡造影,再行血管造影;阴性者应严密观察至出血期检查;大出血危及生命者须积极剖腹探查。

Objective To investigate the rational diagnostic methods of small intestinal bleeding by analyzing 30 cases of small intestinal bleeding confirmed by surgery and pathology.Methods 30 cases of small intestinal bleeding were examined by enteroclysis,radionucleide scanning,angiography,exploratory la- parotomy and intraoperative colonoscopy,and final diagnosis was made by surgery and pathology in all patients.Results Lesions in 18 out of the 20 cases of active bleeding were detected preoperatively,4 of the 9 cases during bleeding interval were positive,laparotomy and intraoperative colonoscopy estab- lished final diagnosis in the remaining 7 cases in which preoperative procedures failed to find bleeding spot and in one who underwent emergent laparotomy for massive bleeding.The positive rate and bleed- ing localizing rate of enteroclysis,radionucleide scanning and angiography were:46.2%(6/13)and 66.7%(4/6),87.5%(14/16)and 42.9%(6/14),66.7%(10/15) and 90.0%(9/10),respectively.Con- clusions (1)Active bleeding without severe shock should be evaluated firstly by radionucleide scan- ning,then angiography,finally laparotomy;(2)During bleeding interval patients should be evaluated by enteroclysis,then angiography,and expectant observation until bleeding resumes;(3)Those with lethal massive bleeding,not permitting any delay,should undergo laparotomy.