空回肠出血性疾病病因分析—附66例报告

Etiology Study of Jejuno-Ileum Bleeding Disease—Rrport of 66 Cases

目的 :通过对手术及病理证实的 66例空回肠出血患者进行分析 ,探讨出血的病因诊断。方法 :对 66例空回肠出血患者分别行结肠镜检 ,小肠气钡造影 ,选择性血管造影 ,均经手术及病理证实诊断。结果 :出血原因中 ,肿瘤 2 7例 (40 .9% ) (其良性肿瘤与恶性肿瘤比例相近 ) ,憩室 1 4例 (2 1 .2 % ) ,非特异性炎症 1 0例 (1 5 .1 % ) ,肠结核 4例 (6 .1 % ) ,急性坏死性小肠炎 3例 (4.5 % ) ,肠伤寒 2例(3 % ) ,感染性疾病 1 9例 (2 8.8% ) ,克隆病 2例 (3 % ) ,肠系膜动脉血栓形成 4例 (6 .1 % )。结肠镜检查阳性率 1 0 .6 % (5/ 4 7) ,小肠气钡造影阳性率 1 1 .1 % (1 / 9) ,选择性动脉造影阳性率 40 % (2 / 5)。结论 :本组空回肠出血病因中肿瘤占出血原因首位 ,感染性疾病及憩室占的比例较高。选择性动脉造影对肠系膜动脉病变具有重要诊断价值。但基层医务人员应根据条件选择适合的特殊检查 ,以尽早明确诊断 。

Purpose:To discriminate etiology of bleeding by studing 66 cases of jejuno-ileum bleeding which were diagnosed through surgery and patholegy.Methods:66 patients with jejuno-ileum bleeding were respectively performed colonoscopy,gas-barium radiegraphy of small intestine and selective angioraphy.All patients were dertermined by surgery and pathology.Results:Among bleeding etiology,27 cases (40.9%) were tumour,in which the ratio of benign mass to carcinoma was almost the same,14 cases (21.2%) were diverticulum,10 cases (15.1%) were non-specific inflammation,4 cases (6.1%) were intestinal TB,3 cases (4.5%) were acute necrotic enterotitis and 2 cases (3%) were intestinal typhoid.The total infective disease was 19 cases (28.8%);2 cases(3%) were Crohn's disease,and 4 cases (6.1%) were thrombosis of mesenteric artdery.The positive rate of colonscopy,gas-barrium,radigraphy of intestine and selective angiography was 10.6%(5.47),11.1%(1/9) and 40% (2/5) respectively.Conclusion:Tumour was major etiology of jejuno-ileum bleeding disease in this group,in which the rate of infective disease and diverticulum were also high.Selective angiography has important diagnostic value in mesenteric artery disease.But the doctor of basie organization should choice proper examination on the basis of local condition to determine diagmosis and select proper therapy.