不同检查方法对急诊便血病因诊断的比较研究

Comparison study of different diagnostic modalities on hematochezid etiology in emergency

目的分析5种不同检查方法对急诊便血患者病因诊断的有效性。方法回顾性分析2007年1月至2011年2月在本院急诊科以便血就诊而住院治疗的183例患者的临床资料，分析单用或者联合使用结肠镜、胃镜、胶囊内镜、双气囊小肠镜、CT5种检查方法对便血病因诊断的阳性率。结果结肠镜是最主要的和最基本的检查手段，能明确绝大部分便血病因。接受单纯结肠镜检查的169例患者中，其诊断阳性率为84．62％（143／169）。结肠镜＋胃镜＋胶囊内镜的诊断阳性率为89．39％（160／179），结肠镜＋胃镜＋双气囊小肠镜的诊断阳性率为94．41％（169／179），结肠镜＋胃镜＋胶囊内镜＋双气囊小肠镜的诊断阳性率为96．65％（173／179），5种检查手段联合的诊断阳性率为96．72％（177／183），与单纯结肠镜检查的诊断阳性率比较，差异均具有统计学意义（均P〈0．01）。结论结肠镜是便血病因最主要、最基本的检查手段。对于结肠镜仍未能明确诊断者，多种检查手段的综合利用有助于提高诊断阳性率。

Objective To evaluate the efficiency of 5 diagnostic modalities for hematochezia in emergency. Methods Data of patients who visited our Department of Emergency clue to hematochezia between January 2007 and February 2011 were reviewed. The rates of positive findings as detected with single or combination of colonoscopy, gastroscopy, capsule endoscopy, double- balloon enteroscopy and computerized tomography were calculated and compared. Results Among these patients, colonoscopy was the important and common modality that definitely led to identification of etiology in most of the time. The rate of positive findings was 84.62% in 169 patients who underwent colonoscopy alone, 89.39% （160/179） in those who underwent colonoscopy, gastroscopy and capsule endoscopy, 94.41% （169/179） who underwent colonoscopy, gastroscopy and double balloon enteroscopy, 96.65% （173/179） in those who underwent colonoscopy, gastroscopy, capsule endoscopy and double balloon enteroscopy, and 96.72% （177/183） in those who underwent all of the 5 diagnostic modalities. The rate of detection with multi-modality diagnosis was significantly different as compared with use of colonoscopy alone （all P〈0.01）. Conclusions Colonoscopy is the important and common modality for etiological diagnosis of hematochezia. In patients with causes unexplained by colonoscopy, combined use of muhi-modality diagnosis may help improve the rate of positive detection.