下消化道出血60例诊断分析

Diagnosis of lower gastrointestinal bleeding of 60 cases

目的探讨少见原因引起下消化道出血的诊断方法。方法对近20年内经手术明确诊断的60例下消化道出血病人术前的诊断方法进行回顾性分析。结果小肠钡餐检查的阳性检出率为16.9%(10/59),气钡双重造影的阳性率为20.0%(3/15),选择性肠系膜动脉造影阳性检出率为79.5%(35/44),CT的阳性率为26.3%(5/19),核素扫描的诊断符合率为58.3%(21/36)。78.3%(47/60)病变位于空、回肠,21.7%(13/60)位于结、直肠。血管畸形占33.3%(20/60),小肠间质瘤占30.0%(18/60)。结论合理掌握各种诊断手段的适应证和时机可望早期诊断下消化道出血。经动脉导管放置钢丝标记出血部位有益术中找出病灶所在肠段。

Objective To explore the diagnosis of lower gastrointestinal bleeding because of the rare reasons. Methods The diagnosis of 6% patients with lower gastrointestinal bleeding because of the lesser diseases admitted to our hospital in 20 years was analyzed retrospectively. Results The sensitivity of the routine small bowel X-ray, enteroclysis double-contrast study, angiography, CT, nuclear scans was 16. 9%（10/59） ,20.0）%（3/15） ,79. 5%（35/44） ,26. 3 %0（5/19） and 58. 3 %0（21/36） respectively. Bleeding site in j ej unum and（or）ileum was the most common accounting for 78. 3% （47/60）. Bleeding in colon and （or）rectum accounted for 21.7 % （13/60%）. Vascular malformations were the most common causes of lower gastrointestinal bleeding accounting for 33. 3%（20/60）. Leiomyoma of the small bower accounted for 30. 0% （18/60）. Conclusion A profound grasp of the indications and appropriate timing of various examinations is promising for the early diagnosis of lower gastrointestinal bleeding.