推进式双气囊电子小肠镜对不明原因小肠出血的病因诊断  

Double-balloon push enteroscopy for patients with obscure small bowel bleeding

作　　者：张晨莉[1] 钟捷[1] 张吉[1] 蒋慧[1] 吴云林[1] 江石湖[1] 

机构地区：[1]上海第二医科大学附属瑞金医院消化科

出　　处：《中华消化内镜杂志》2004年第6期381-384,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的 通过对不明原因消化道出血患者行双气囊电子小肠镜检查,评价双气囊电子小肠镜对小肠出血的诊断价值。方法 2003年4月至11月,对34例疑为小肠出血患者行推进式双气囊电子小肠镜检查,结合手术和病理做出病因诊断。结果 在34例患者中30例发现病灶,检查总体阳性率为88.2％。4例阴性患者中,1例内镜抵达空肠中段,3例抵达回肠中下段。30例阳性患者中,血管病变7例(占20.6％,位于空肠1例,空回肠3例,回肠3例);小肠肿瘤11例(占32.4％,均经手术及病理证实,位于十二指肠2例,空肠5例,回肠4例。肿瘤性质分别为:间质肿瘤3例,脂肪瘤1例,平滑肌瘤2例,血管瘤2例,嗜铬细胞瘤1例,Kaposi型血管内皮瘤1例,腺癌1例);克罗恩病4例(占11.8％,位于空回肠部);其他8例。结论 小肠血管病变、小肠肿瘤及小肠克罗恩病为不明原因小肠出血最常见病因;推进式双气囊电子小肠镜是一项安全、直观、可靠、有效的检查手段,对不明原因小肠出血具有较高临床诊断价值。Objective To evaluate the diagnostic value of double-balloon push enteroscopy in patients with obscure small bowel bleeding. Methods Thirty-four cases with suspected small bowel bleeding were received double-balloon push enleroscopy from April to November 2003. Results The lesions were detected in 30 of 34 cases; the total diagnostic yield was 88. 3% . The enteroscopy reached to middle jejunum, middle or low portion of ileum in 1 and 3 cases with negative findings. Among thirty positive cases, the diagnosis were angiodysplasia 7 cases (20.6% , 1 in jejunum, 3 in jejunal-ileum, 3 in ileum) , small bowel tumor 11 cases (32.4% ) , all cases were certified by operation and pathology. The tumor growth in duodenum, jejunum and ileum were 2, 5 and 4 cases respectively. Pathology of incised tumors included lipoma, leiomyoma hemangioma, pheochromoeytoma, Kaposiform hemangioendothelioma and adenoearcinoma, 4 cases with Crohn's disease (11. 8% ) , and 8 cases in others. Conclusion The most common causes of obscure small bowel bleeding were angiodysplasia, small bowel tumor and Crohn's disease. Double-balloon push enleroscopy was a safe, reliable and effective diagnostic modality with high clinical value for obscure small bowel bleeding.

关 键 词：推进式双气囊电子小肠镜 小肠出血 病因诊断 间质肿瘤 脂肪瘤 平滑肌瘤 血管瘤 

分 类 号：R574[医药卫生—消化系统]