147例中老年小肠出血患者临床特征和预后分析  

Clinical characteristics and prognosis of 147 cases middle-aged and elderly patients with small bowel bleeding

作　　者：周耘辉 周心怡 刘宁宁 周琳[1] ZHOU Yunhui;ZHOU Xinyi;LIU Ningning;ZHOU Lin(Department of Gastroenterology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院消化内科,河南郑州450052

出　　处：《胃肠病学和肝病学杂志》2024年第11期1452-1458,共7页Chinese Journal of Gastroenterology and Hepatology

基　　金：国家自然科学基金(81472325);河南省中青年卫生健康科技创新领军人才培养项目(YXKC2021017)。

摘　　要：目的探讨中老年人群小肠出血的临床特征,为中老年人群小肠出血的诊疗提供依据。方法纳入2015年1月1日至2021年1月1日在郑州大学第一附属医院确诊为小肠出血的中老年患者共147例,对其一般情况、实验室检查、影像学检查、治疗与预后进行回顾性分析。结果147例小肠出血患者中,常见的病因依次为血管性病变(36.1%)、肿瘤性病变(34.7%)及炎症性病变(34.0%);分别以血管畸形(81.1%)、间质瘤(62.7%)、溃疡性病变(46.0%)和糜烂性病变(40.0%)更为多见。血管畸形组、间质瘤组与炎症性病变组三组小肠出血患者的显性出血率、胃肠道反应的发生率及合并腹部手术史的比例均不同[93.0%(40/43)vs 84.4%(27/32)vs 72.0%(36/50)、9.3%(4/43)vs 43.8%(14/32)vs 40.0%(20/50)、20.9%(9/43)vs 12.5%(4/32)vs 46.0%(23/50)],差异有统计学意义(χ^(2)=7.161、13.919、12.659,P均<0.05);Bonferroni法两两比较显示,血管畸形组腹痛的发生率低于间质瘤组及炎症性病变组(P均<0.05);炎症性病变组合并腹部手术史的比例高于血管畸形组和间质瘤组(P均<0.05)。在三组表现为显性出血的患者中,黑便较血便更多见(P均<0.05)。计算机断层扫描对肿瘤的阳性检出率高于血管性病变和炎症性病变(P<0.01);经口小肠镜对中老年小肠出血的总体检出率高于经肛小肠镜(P<0.05)。结论中老年小肠出血的常见病因构成为血管性病变、肿瘤性病变和炎症性病变,不同病因引起的小肠出血有一定的临床特征,可为临床经验性诊断小肠出血提供一定的依据。中老年小肠出血以黑便较为多见,血管畸形组患者更少发生胃肠道反应,炎症性病变组患者常合并有腹部手术史;相比于经肛小肠镜,经口小肠镜在中老年小肠出血患者中有更高的总体检出率。Objective To investigate the clinical features of small bowel bleeding in middle-aged and elderly people,so as to provide the basis for the diagnosis and treatment of small bowel bleeding in them.Methods A total of 147 middle-aged and elderly patients diagnosed with small bowel bleeding at the First Affiliated Hospital of Zhengzhou University from Jan.1st,2015 to Jan.1st,2021 were enrolled,and a retrospective analysis was performed on general condition,laboratory examination,imaging study,treatment and prognosis.Results Among the 147 patients with small bowel bleeding,the common etiologies were vascular(36.1%),neoplastic(34.7%)and inflammatory lesions(34.0%)in that order;vascular malformations(81.1%),stromal tumors(62.7%),ulcerative(46.0%)and erosive lesions(40.0%)were more common,respectively.The rate of overt bleeding,the incidence of gastrointestinal reactions and the proportion of combined abdominal surgery history were different among the three groups of small bowel bleeding patients in the vascular malformation,stromal tumor and inflammatory lesion groups[93.0%(40/43)vs 84.4%(27/32)vs 72.0%(36/50),9.3%(4/43)vs 43.8%(14/32)vs 40.0%(20/50),20.9%(9/43)vs 12.5%(4/32)vs 46.0%(23/50)],and the differences were statistically significant(χ^(2)=7.161,13.919 and 12.659,all P<0.05).Bonferroni pairwise comparisons showed that the incidence of abdominal pain was lower in the vascular malformation group than that in the stromal tumor and inflammatory lesion group(both P<0.05),the proportion of inflammatory lesion group combined with a history of abdominal surgery was higher than in the vascular malformation and stromal tumor groups(both P<0.05).In all three groups presenting with overt bleeding,melena was more common than bloody stool(all P<0.05).Computed tomography had a higher positive detection rate for tumors than for vascular and inflammatory lesions(P<0.01);the overall detection rate of small bowel bleeding in middle-aged and elderly people was higher with peroral small intestinal endoscopy than small intestinal en

关 键 词：小肠出血 中老年 临床特征 小肠镜 胶囊内镜 

分 类 号：R574[医药卫生—消化系统]