手术证实的79例小肠出血诊断分析  

Diagnosis of small intestinal bleeding:analysis of 79 cases confirmed by surgery

作　　者：朱萱[1] 王崇文[1] 徐萍[1] 

机构地区：[1]江西医学院第一医院,南昌市330006

出　　处：《中华消化杂志》1997年第2期70-72,共3页Chinese Journal of Digestion

摘　　要：：通过对手术证实的79例小肠出血进行分析，探讨小肠出血的病因诊断。方法：79例小脑出血分别行小肠气钡造影、选择性血管造影、99mTc扫描、剖腹探查及术中胸镜检查，最后均得到手术及病理证实。结果：出血原风中，肿瘤39例（49．4％），以息肉、平滑肌瘤和肉瘤居多；憩室和出血坏死性小肠炎均为10例（12．6％）；伤寒及克隆病均为8例（10．1％）在肠血管畸形3例（3.8％）;其它1例。选择性动脉造影阳性率达75％（9／12）；核素扫描阳性率为50％（2／4）；小肠气钡造影为10．4％（2／19）；6例剖腹探查，4例阳性，2例借助术中肠镜发现病变。结论：肿瘤占出血原因首位；出血坏死性小肠炎及伤寒也占较高比例（22．7％），选择性动脉造影对小肠肿瘤的诊断有重要价值，原因不明的反复出血应及时剖腹探查，术中肠镜可提高阳性发现．Objectives: To investigate the etiologic diagnosis of small intestinal bleeding byanalyzing 79 cases of small intestinal bleeding confirmed by surgery. Methods: 79 cases of smallintestinal bleeding were diagnosed by enteroclysis, angiography, radionucleide scanning,exploratory laparotomy and intraoperative colonoscopy, which were confirmed by surgery andpathology. Results: Small intestinal tumors were found in 39 cases (49.4％), among them, polyp in9,leiomyosarcoma in 8 and leiomyoma in 7. Diverticulum and acute hemorrhagic necrotizingenteritis were seen in lO cases (12.6％) each, typhoid and Crohn's disease in 8 (1O.1％) each;angiodysplasia in 3 (3.8％). Angiography was performed in 12 and 9 of them were abnormal.Radionucleide scanning was positive in 2 out of 4 cases. Exploratory laparotomy was performed in 6and 4 was found to have some lesions, the other 2 were diagnosed by intraoperative colonscopy.Conclusions: Tumor is the most common cause of small intestinal bleeding, and acute hemorrhagicnecrotizing enteritis and typhoid had a higher rate too- Angiography is one of the most usefuldiagnostic procedures, exploratory laparotomy is necessary for repeated small intestinal bleeding ofobscure origin whereas intraoperative colonscopy is helpful.

关 键 词：胃肠道出血 小肠 出血 病因学 诊断 

分 类 号：R656.704[医药卫生—外科学]