25例小肠出血的临床诊断分析  

Clinical Diagnosis Of Small Intestine Hemorrhage-Analysis Of 25 Cases

作　　者：李初俊[1] 陈白莉[1] 胡品津[1] 

机构地区：[1]中山医科大学附属一医院消化内科,广州市510080

出　　处：《胃肠病学和肝病学杂志》1997年第4期351-354,共4页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的和方法:对我院25例经手术及病理证实的、十二指肠降段以下的小肠出血病例,就出血病因、病变部位、血表现、腹部体征与诊断手段等进行临床分析.结果:结果显示出血病因以小肠肿瘤为主,占40%(10/25),并以恶性肿瘤为主,其次为感染性疾病占28%(7/25)、小肠憩室占20%(5/25)、血管瘤占12%(3/25),与国内其它文章的报道相似.出血的主要表现为血便或黑便,其无法提示出血部位,而与出血量和出血速度相关,空肠上段出血量较大者可伴有呕血.有腹部明显压痛者多为炎症性小肠疾病或恶性肿瘤,扪及腹部包块常提示为恶性肿瘤.术前已明确出血部位的有17例,术前诊断率为68.0%(17/25).18例非感染性疾病中有11例术前通过影像学检查明确出血部位,术前诊断率为61.1%(11/18),其中13例经全胃小肠钡餐检查,5例为阳性,阳性率为38.5%(5/13),均为小肠肿瘤;另外5例行核素扫描检查、1例行选择性肠系膜上动脉造影检查,均为阳性.结论:对不明原因的小肠反复血病例,应将插管法小肠灌肠双重对比造影作为常规检查以提高检查的阳性率,出血期间行核素扫描或/及选择性动脉造影检查可进一步提高诊断率,对特殊病例有条件可开展小肠镜检查.Aim and Methods: Clinical analysis has been conducted upon 25 cases of small intestine hemorrhage below the descending part of duodenum in regard to etiology, bleeding sites, manifestation, abdominal signs and diagnostic means. All the cases are confirmed by either operation or pathological assessment.Results: The results demonstrate that small intestine tumors comprise the majority of bleeding causes (40% , 10/25) with malignancy being predominant. Infectious diseases rank second (28% ,7/25),followed by small intestine diverticulosis (20% ,5/25)and angioma(12% ,3/25) .The dramatic presentations of bleeding are hematochezia or mlena which suggests no clue to bleeding sites. The cases of jejunal lesion with massive hemorrhage may be accompanied by hematemesis. Those with drastic abdominal pains mostly suffer from inflammatory small intestine disorders or malignancy.Palpable abdominal masses harbinger malignant tummors in most cases.The underlying sources of 17 bleeding cases have been ascertained before operation.Thus,the preoperational diagnosing rate is 68.0% (17/25).The bleeding sites of 11 cases ammong 18 non-infectious diseases patients (61.1% ,11/18)are clarified through imaging.Only 5 cases of those 13 patients (38.5% ,5/13)who undertake GI tract barium enema show positive findings and are in all diagnosed as small bowel tumors.The upshots of both 5 cases in radionuclide scanning and 1 case in selective an-giography of mesenteric artery among the same group manifest observable changes. Conclusions: As to small intestine bleeding cases with unknown causes , infusion small bowel barium enema is recommended as a routine examination to improve diagnostic visualization.Radionuclide scanning and selective arterial angiography might promote diagnostic accuracy. If avail-able,small bowel endoscopy is indicated in special cases.

关 键 词：诊断 小肠出血 小肠疾病 

分 类 号：R574.504[医药卫生—消化系统]