小肠出血病因及手术预测因素分析

The Etiology of Small Intestinal Bleeding and The Analysis of Operation Correlative Factors

目的利用双气囊小肠镜与胶囊内镜研究小肠出血的病因,分析不同病变之间、手术组与非手术组之间各项血液检测指标的差异,探索与手术治疗相关的可能因素。方法本次研究共纳入61名既往经胃镜、肠镜检查均未能明确病因的消化道出血患者。37名患者接受双气囊小肠镜检查,首选进镜方式为经口或经肛两种,如未能发现病变,则日后改换另一种方式进镜检查。24名患者接受胶囊内镜检查。所有患者入院后均接受常规血液检测。结果双气囊小肠镜病变检出率为78.4%,胶囊内镜病变检出率为75%,两者间无显著差异(χ^2=0.11,P>0.05)。小肠出血的病因以血管病变及溃疡为主,分别为26.2%(16/61)及21.3%(13/61)。共有17名患者接受手术治疗,小肠肿瘤是主要的手术病因,占52.9%(9/17)。在行胶囊内镜检查的患者中,手术治疗组的血红蛋白明显低于非手术组[(68.50±5.80)g/L vs.(92.40±27.58)g/L,P=0.002]。在行小肠镜检查的患者中,手术治疗组患者入院时的心率高于非手术组[(93.08±16.65)次/分vs.(80.71±10.98)次/分,P=0.03],心率与接受手术治疗之间呈正相关(r=0.366,P=0.026)。结论血管病变及溃疡是小肠出血的首要原因,小肠肿瘤是手术治疗的主要病因。血红蛋白下降、心率增快可作为预测手术必要性的有效指标。

Objective The study aimed to analyze the etiology of small intestinal bleeding,to compare thedifferences of factors related anemia among patients with different diseases or with different examinations,and to evaluatethe potential factors correlated to operation.MethodsSixty one patients were included in the study. The double-balloonenteroscopy(DBE)was performed in 37 patients either with the oral/anal route alone or with combined approaches andthe wireless capsule endoscopy(CE)was performed in 24 patients. All the patients received conventional blood tests.ResultsThe detection rate of DBE and CE was 78.4% and 75% respectively. The difference was not significant(χ^2=0.11,P>0.05). The main causes were vascular lesions and ulcers,which were 26.2%(16/61) and 21.3%(13/61)respectively. A total of 17 patients underwent surgery. Tumors were the main cause of operation,accounting for 52.9%(9/17). For patients with CE examination,the hemoglobin was lower in the group with operation[(68.50±5.80)g/L vs.(92.40±27.58)g/L,P=0.002]. For patients with DBE examination,the heart rate at admission was higher in the groupwith operation[(93.08±16.65) beats/min vs.(80.71±10.98) beats/min,P=0.03]. There was a positive correlationbetween heart rate and operation(r=0.366,P=0.026).ConclusionThe vascular lesions and ulcer were the main causesfor small intestinal bleeding. Tumors were the main cause of operation. Decreased hemoglobin and increased heart ratemay be effective indicators for predicting the necessary of surgery.