急诊CT结合早期结肠镜检查对急性下消化道出血诊断作用的研究

Emergency CT combined with early colonoscopy in the diagnosis of acute lower gastrointestinal bleeding

目的 评价急诊CT结合早期结肠镜检查诊断急性下消化道出血（LGIB）的准确性与安全性。 方法 回顾性分析连云港市赣榆区人民医院胃肠外科急诊入院接受结肠镜检查的316例LGIB患者的临床资料。根据检查方法不同，将患者分为急诊CT结合早期结肠镜诊断组（CT＋结肠镜组，n=178）与单独早期结肠镜诊断组（结肠镜组，n=138），比较两种方法诊断患者LGIB血管病变与非血管病变的检出率，分析急诊CT检查诊断病变的准确性。 结果 CT＋结肠镜组较结肠镜组血管病变检出率［36.0%（64/178） vs. 20.3%（28/138）， χ2=9.243， P=0.002］、内窥镜治疗率 ［34.8%（62/178）vs. 13.0%（18/138）， χ2=19.517，P＜0.001］ 明显提高，急诊CT结合早期结肠镜检查诊断LGIB患者血管病变、非血管病变的敏感度、特异度分别为37.5%（26.0%～50.5%）、88.6%（80.9%～93.5%）与81.81%（59.0%～94.0%）、80.8%（73.5%～86.5%），CT＋结肠镜组没有患者发生造影剂肾病。 结论 急诊CT结合早期结肠镜诊断LGIB可以明显提高血管病变检出率，促进患者尽快进行内窥镜治疗，安全性高，值得临床推广应用。

Objective To evaluate the accuracy and safety of emergency CT combined with early colonoscopy in the diagnosis of acute lower gastrointestinal bleeding （LGIB）. Methods A retrospective study was conducted to analyze the clinical data of 316 patients with acute LGIB who underwent early colonoscopy at the emergency department of gastroenterology in our hospital. According to the different examination methods, the patients were divided into two groups： the emergency CT combined with early colonoscopy group （emergency CT group, n = 178 ） and early colonoscopy alone group （colonoscopy group, n = 138）. The two methods to diagnose patients with LGIB vascular lesions and non - vascular lesions detection rate were compared. The diagnostic accuracy of emergency CT and the predictors of vascular bleeding were analyzed. The effect of emergency CT on clinical prognosis and serum creatinine was evaluated. Results The detection rate of vascular lesions [ 36.0% （64/178） vs. 20.3% （ 28/138 ）, X2 = 9. 243, P = 0. 002 ] and the proportion of endoscopically treated patients [34.8% （62/178） vs. 13.0% （ 18/138）, X2 = 19. 517, P 〈0.001 ] in the emergency CT group was significantly higher than that in the colonoscopy group. The sensitivity and specificity of emergency CT combined with early colonoscopy in the diagnosis of vascular lesions and non - vascular lesions in LGIB patients were 37.5% （26.0% ～50.0%）, 88.6% （80.9% ～93.5%） and 81.81% （59.0% 94.0% ）, 80.8% （73.5% ～ 86. 5% ） , respectively. No patients in the emergency CT group had contrast nephropathy. Conclusion The combination of emergency CT and early eolonoseopy in the diagnosis of LGIB can significantly increase the detection rate of vascular lesions, with high safety. The method of diagnosis can promote patients as soon as possible endoscopic treatment, and worthy of clinical application.