小肠出血性病变诊断方法的比较与病因分析

Analysis of etiology and comparison of diagnostic methods on hamorrhagic lesion of small intestine

目的 比较各种诊断方法和分析病因及相关的临床表现 ,提高对小肠出血的认识和诊断。方法 总结北京协和医院近 15年 37例以疑难病例为主 (2 5例 )的小肠出血。结果 1、病因与特点 本组病因如下 :血管畸形 (19例 )、克隆氏病 (3例 )、回肠息室、白塞氏病、伤寒 (均为 2例 ) ;1例的有过敏性紫癜、结节性动脉炎、小肠重复畸形、小肠异位胰腺、小肠结石、钩虫病、结核、平滑肌肉瘤和恶性淋巴瘤 ;2、诊断方法 (1)确定出血部位 核素显像敏感性 (89% ) >血管造影 (83 % )吞线 (6 6 6 5 % ) >小肠气钡(2 8% ) >全消化道造影 (13 3 % )。 (2 )与病变的相关性 核素显像阳性的病例为慢性反复出血 (75 % )或急性中等量出血 (2 5 % ) ,而血管造影阳性中 5 6 %为急性大出血 ;X线钡剂造影 (小肠气钡和全消 )均有狭窄或腹块病变存在。对慢性反复出血者建议选用核素显像 ,对血管造影急性大出血时、对有或疑有占位性或肠腔狭窄病变可选用小肠气钡及全消化道造影检查。

Aim To improve the cognition and diagnosis of small intestinal bleeding through comparison of various diagnostic methods, and etiologic and clinical analysis.Method Thirty-seven cases of small intestinal bleeding were studied, mainly involved in 25 cases of questional patients in Xiehe Hospital in the past 15 years.Result 1, Etiological factors and feature: The causes were as follows: vascular malformation occurred in 19 cases, Crohn's Disease in 3 cases, ileointestinal diverticula, Behcet's syndrome and typhoid in 2 cases respectively, and allergic purpura, nodose arteritis, repetitive malformation of small intestine, heterotopic pancreas in small intestine, small intestinal stone, ancylostomiasis, tuberculosis, smooth muscular sarcom and malignant lymphoma in one case respectively; 2, Diagnostic methods (1)Localization of bleeding: The sensitivity of nuclein imaging (89%) was higher than that of angiography (83%), string test (66.65), barium examination contrast to air in small intestine (28), and radiography of whole digestive tract. (2) The correlation with lesion: Chronic recurrent bleeding (75%) or acute moderate bleeding (25%) occurred in the patients with positive nuclein imaging, however, acute severe hemorrhage (56%) occurred in those with positive angiograrhy. The constriction and abdominal mass were found in all the patients by X-ray radiography examination with barium.Conclusion Nuclein imaging can be applied to chronic recurrent bleeding, angiography to acute severe hemorrhage, and barium examination contrast to air in small intestine and radiography examination of whole digestive tract to space occupying lesion or constrictive lesion. If the condition is permitted, operation should be quickly done to decide the etiological factors.