938例下消化道出血的临床病因分析  

Retrospective analysis of colonoscopic characteristics of 938 cases of lower gastrointestinal tract bleeding

作　　者：马娟[1] 邓卫平[1] 曾志刚[1] 刘婉薇[1] 王启仪[1] 沙卫红[1] 

机构地区：[1]广东省人民医院广东省医学科学院消化内科,广州510080

出　　处：《中华急诊医学杂志》2014年第12期1358-1361,共4页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金（81001112）;广州市科技局珠江科技新星专项项目（2012J2200019）

摘　　要：目的回顾性分析938例下消化道出血病因。方法收集我院下消化道出血患者938例，接受结肠镜检查以明确病因，并分析不同年龄组间病因构成差异，卡方检验用于组间率的比较。结果902例经结肠镜检查明确病因，总检出率96．16％。主要病因依次为大肠恶性肿瘤（41．26％）、大肠息肉（12．37％）、炎症性肠病（9．59％）、大肠糜烂溃疡性病变（10．34％）、痔疮出血（8．64％）。青年组、中年组、老年组三组问比较，大肠恶性肿瘤x^2=68．116，df=2，P=0．000）和大肠息肉x^2=9．101，df=2，P=0．011）的发生率显著增加，炎症性肠病（x^2=62．150，af=2，P=0．000）和糜烂溃疡性病变（x^2=20．292，df=2，P=0．000）的发生率则显著下降。结论下消化道出血结肠镜检查阳性检出率高，主要病因为大肠恶性肿瘤、大肠息肉、炎症性肠病、糜烂溃疡性病变、痔疮出血。随着年龄增长，炎症性肠病或糜烂溃疡性炎症导致下消化道出血有所下降，大肠恶性肿瘤或息肉有所增加。Objective To study the etiology, relevant factors and endoscopic characteristics of acute lower gastrointestinal tract hemorrhage. Methods A total of 938 patients receiving emergency colonoscopy for acute lower gastrointestinal tract hemorrhage were collected to study the etiological profiles. Different causes between young group and elderly group were also recorded. Results The total detectable rate of acute lower gastrointestinal tract hemorrhage in respect of causes was 96. 16% （902/938）. The five leading causes were colorectal malignancy （41.26%） , erosive eolorectal polypus （ 12. 37% ） , inflammatory bowel disease （9. 59% ）, erosive and ulcer colitis （10. 34% ） and hemorrhoids （8. 64% ）. Compared with youth and middle age patients, the incidence of colorectal malignancy （ X^2 = 68. 116, dr= 2, P = 0. 000） and colorectal polyps （ X^2 = 9. 101, df = 2, P = 0. 011 ） were significantly increased in elderly patients, while incidence of inflammatory bowel disease （X^2 =62. 150, dr=2, P =0. 000） and erosive and ulcer colitis （X^2 = 20. 292, df = 2, P = 0. 000 ） were significantly decreased in those patients. Conclusions Emergency colonoscopy for diagnosis of acute lower gastrointestinal tract hemorrhage is an important measure. The major manifestation is bleeding resuhing from coloreetal malignancy, erosive colorectal polypus, inflammatory bowel disease, erosive and ulcer colitis and anal hemorrhoid. Age is associated with the cause of lower gastrointestinal tract bleeding induced by different kinds of lesions at the colorectum.

关 键 词：下消化道出血 结肠镜 病因分析 大肠恶性肿瘤 大肠息肉 炎症性肠病 糜烂溃疡性病变 痔疮 青年组 中年组 老年组 

分 类 号：R57[医药卫生—消化系统]