摘要
目的探讨小肠出血的病因及诊断方法。 方法回顾分析 1994年 1月至 1999年 12月小肠出血病人 4 3例 ,经胃镜、结肠镜检查排除十二指肠球部以上消化道和结直肠病变 ,选择应用小肠钡灌、小肠镜、选择性肠系膜血管选影 (DSA)、核素扫描 (ECT)等检查。 结果 4 3例小肠出血病人 ,6例结果阴性予以随访 ,37例检查结果阳性病人予手术探查 ,病理证实。其中小肠肿瘤 2 0例 (5 4 .1% ) ,血管病变 6例 (16 .2 % ) ,克隆 5例 (13.5 % ) ,憩室 3例 (8.1% ) ,炎性肠病 3例 (8.1% )。各检查方法在小肠出血的检查中阳性率分别为 :ECT 6 6 .7% ,DSA 5 3.0 % ,小肠钡灌 4 5 .0 % ,小肠镜 2 8.5 % ,结肠镜 14 .3%。 结论小肠出血临床上常缺乏典型症状 ,在常规胃镜、结肠镜排除胃十二肠球部以上消化道和结直肠病变后 ,考虑小肠疾病至消化道出血的可能 ;缓慢出血者作小肠镜、小肠钡灌检查 ;ECT、DSA适用于活动出血者或其他检查阴性病人 ;伴腹块者B超。
Objective To Analysis and discuss diagnosis of small intestinal hemorrhage. Methods We analyzed 43 patients who had small intestinal hemorrhag from Jan. 1994 ~ Dec.1999.After aliminating pathological changes in both alimentary canal above duodenum and rectum by using gastroscopy ,rectoromanoscopy, we used enteroscope, enteroclysis,DSA and ECT to examine them. Results Among 43 cases of small intestinal bleeding, the negative was 6 and the patients were followed up later, other 37 were positive and had operations.Small bowel tumors were found in 20cases, angiodysplasia in 6. Crohns disease in 5, diverticulum and hemorrhagic enteritis in 3 each. Positive rate of diagnostic methods was followed:ECT 66.7%,DSA 53.0%,enteroclysis 45.0%, and enteroscopy 28.5%. Conclusion Typical symptom of intestinal bleeding is lacked for clinic. After excluding the possibility of pathological changes of rectum,the probability of intestinal hemorrhage could be consi dered. Enteroscopy and enteroclysis should be used first if the patient has chronic hemorrhage, ECT and DSA could be applicable for active bleeding or other positive patients ,CT and B ultrasound is helpful if the patient has abdominal tumor.
出处
《上海第二医科大学学报》
CSCD
2002年第2期172-174,共3页
Acta Universitatis Medicinalis Secondae Shanghai