118例小肠出血临床回顾性分析

A Retrospective Clinical Analysis of 118 Cases of Small Intestinal Bleeding

背景:小肠出血病因复杂,检查方法各有局限,因此难以及时确诊并治疗。目的:分析小肠出血的病因、诊治方法和转归。方法:连续纳入2006年10月—2016年10月第三军医大学大坪医院确诊的小肠出血患者118例,对其临床资料进行回顾性分析。结果:本研究纳入的小肠出血患者临床表现以黑便最为常见(41.5%),其次为暗红色血便、粪隐血阳性、鲜红色血便和不明原因贫血。良恶性肿瘤(43.2%)、血管病变(28.0%)和炎症性病变(15.3%)是小肠出血的主要病因。经胶囊内镜、结肠镜、数字减影血管造影(DSA)、全消化道钡餐、多层螺旋CT(MSCT)、CT小肠造影(CTE)明确出血部位和病因后,41例患者行外科手术治疗,7例行选择性血管造影栓塞治疗,2例行内镜治疗,56例行内科保守治疗,均成功止血;11例患者放弃治疗,1例因大出血抢救无效死亡。结论:小肠出血的首要病因是肿瘤,其次是血管病变和炎症性病变。胶囊内镜检查的病变检出率最高,MSCT临床应用最广。除常规治疗外,外科手术、介入和内镜治疗亦为小肠出血的重要治疗方法。

Background： Small intestinal bleeding is difficult to diagnose and treat because of its complex etiology and limit to examination method. Aims： To analyze the etiology,diagnosis,treatment and prognosis of small intestinal bleeding.Methods： The clinical data of 118 consecutive patients with small intestinal bleeding admitted from Oct. 2006 to Oct.2016 at Daping Hospital,the Third Military Medical University were retrospectively analyzed. Results： Melena was the most common manifestation of small intestinal bleeding（ 41. 5%）,followed by dark bloody stool,positive fecal occult blood test,hematochezia,and anemia with unknown cause. The major causes of bleeding were benign or malignant tumors（ 43. 2%）,vascular lesions（ 28. 0%） and inflammatory lesions（ 15. 3%）. Diagnosis was made by means of capsule endoscopy,colonoscopy,digital subtraction angiography（ DSA）,barium meal examination,multi-slice CT（ MSCT） and CT enterography（ CTE）. Forty-one patients were treated by surgical operation,7 by selective arterial embolization,2 by endoscopic therapy,56 by conservative therapy,and all these patients achieved hemostasis. One patient died of massive hemorrhage and 11 were discharged with giving up of treatment. Conclusions： The leading cause of small intestinal bleeding is tumor,followed by vascular and inflammatory lesions. Capsule endoscopy is able to make definite diagnosis with high accuracy,and MSCT is the most widely used diagnostic approach. In addition to conventional treatment,surgical operation,interventional and endoscopic therapies also play important roles in treating small intestinal bleeding.