小肠出血207例临床分析

摘要

目的 探讨小肠出血的临床特点、病因及检查方法.方法 回顾性分析207例小肠出血患者的临床资料.结果 207例患者中,行胶囊内镜检查48例,发现小肠病变40例,诊断率为83.33%;小肠镜检查62例,发现小肠病变51例,诊断率为82.26%;行腹部CT检查140例,发现小肠病变35例,诊断率为25.00%;行数字减影血管造影术11例,发现小肠出血2例,诊断率为18.18%;行剖腹探查术12例,其中行小肠部分切除术10例,未行手术治疗2例.不明原因小肠出血86例(41.55%,排除胃、十二指肠球部以上及结直肠出血),小肠占位性病变44例(21.26%,病理类型未定的肿瘤33例,经病理确诊的恶性肿瘤9例、脂肪瘤2例),小肠血管病变32例(15.46%,毛细血管扩张22例,血管发育不良及畸形9例,小动脉破裂1例),小肠憩室19例(9.18%,发现梅克尔憩室3例),小肠溃疡12例(5.80%),小肠钩虫感染5例(2.42%),小肠炎症7例(3.38%),炎症性肠病2例(0.97%).结论 不同病因所致的小肠出血在临床表现上没有特征性,不明原因小肠出血及小肠占位性病变为小肠出血较常见的病因.胶囊内镜对血管畸形所致的小肠出血诊断效果好,对有手术指征的小肠出血患者应及时行外科手术治疗.%Objective To investigate the clinical features,etiology and examination methods of small intestinal bleeding.Methods Clinical data of 207 patients with small intestinal bleeding were analyzed retrospectively.Results Among the 207 patients among the 48 patients who un-derwent capsule endoscopy,small intestinal lesions were found in 40(83.33%).Among the 62 pa-tients who underwent intestinal endoscopy,small intestinal lesions were found in 51(82.26%).A-mong the 140 patients who underwent abdominal CT examination,small intestinal lesions were found in 35(25.00%).Among the 11 patients who underwent digital subtraction angiography, small intestinal bleeding was found in 2(18.18%).Among the 12 patients who underwent explor-atory laparotomy,10 received partial intestinal resection,but 2 did not receive surgical treatment. Obscure small intestinal bleeding occurred in 86(41.55%,excluding those with gastric,duodenal and colorectal bleeding),small intestine space-occupying lesions in 44(21.26%,uncertain patho-logical type of tumor in 33,pathologically confirmed malignant tumor in 9,and lipoma in 2),small intestinal vascular lesions in 32(15.46%,telangiectasis in 22,vascular dysplasia and malformation in 9,and small artery rupture in 1),small bowel diverticulosis in 19(9.18%,Meckel''''''''''''''''s diverticu-lum in 3),small intestinal ulcer in 12(5.80%),hookworm infection in 5(2.42%),small intestinal inflammation in 7(3.38%),and inflammatory bowel disease in 2(0.97%).Conclusion Different causes of small intestinal bleeding have no typical clinical manifestations.Obscure bleeding andspace-occupying lesions are the most common causes of small intestinal bleeding.Capsule endoscopyis effective for diagnosing small intestinal bleeding caused by vascular malformation,and surgical treatment should be performed timely in patients with operation indications.