118例小腸出血臨床回顧性分析

匡 怡 湯 琴 劉 念 崔紅利 陳東風(fēng) 賴姝婕*

第三軍醫(yī)大學(xué)大坪醫(yī)院野戰(zhàn)外科研究所肝膽外科1(400042) 消化內(nèi)科2

118例小腸出血臨床回顧性分析

匡 怡1湯 琴2劉 念2崔紅利2陳東風(fēng)2賴姝婕2*

第三軍醫(yī)大學(xué)大坪醫(yī)院野戰(zhàn)外科研究所肝膽外科1(400042)消化內(nèi)科2

背景：小腸出血病因復(fù)雜，檢查方法各有局限，因此難以及時確診并治療。目的：分析小腸出血的病因、診治方法和轉(zhuǎn)歸。方法：連續(xù)納入2006年10月—2016年10月第三軍醫(yī)大學(xué)大坪醫(yī)院確診的小腸出血患者118例，對其臨床資料進行回顧性分析。結(jié)果：本研究納入的小腸出血患者臨床表現(xiàn)以黑便最為常見(41.5%)，其次為暗紅色血便、糞隱血陽性、鮮紅色血便和不明原因貧血。良惡性腫瘤(43.2%)、血管病變(28.0%)和炎癥性病變(15.3%)是小腸出血的主要病因。經(jīng)膠囊內(nèi)鏡、結(jié)腸鏡、數(shù)字減影血管造影(DSA)、全消化道鋇餐、多層螺旋CT(MSCT)、CT小腸造影(CTE)明確出血部位和病因后，41例患者行外科手術(shù)治療，7例行選擇性血管造影栓塞治療，2例行內(nèi)鏡治療，56例行內(nèi)科保守治療，均成功止血；11例患者放棄治療，1例因大出血搶救無效死亡。結(jié)論：小腸出血的首要病因是腫瘤，其次是血管病變和炎癥性病變。膠囊內(nèi)鏡檢查的病變檢出率最高，MSCT臨床應(yīng)用最廣。除常規(guī)治療外，外科手術(shù)、介入和內(nèi)鏡治療亦為小腸出血的重要治療方法。

胃腸出血； 胃腸腫瘤； 體層攝影術(shù)，螺旋計算機； 回顧性研究

Correspondenceto: LAI Shujie, Email: laisj130@163.com

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.

KeywordsGastrointestinal Hemorrhage; Gastrointestinal Neoplasms; Tomography, Spiral Computed; Retrospective Studies

小腸具有路徑長、彎曲多的解剖學(xué)特點，相關(guān)疾病的臨床癥狀和體征多不典型，常規(guī)檢查方法局限性大，因此小腸出血的診斷十分困難，臨床上常出現(xiàn)漏診、誤診。……