经内镜氩离子凝固术治疗10例结肠血管畸形

结肠血管畸形是不明原因消化道出血的病因之一,随着出血早期电子结肠镜检查的普及,结肠血管畸形已成为不明原因的下消化道出血尤其是老年人反复发生的不明原因的下消化道出血常见病因之一。我院从2006年1月至2009年1月,对下消化道出血患者行急诊结肠镜检查,其中明确诊断10例,给予氩离子凝固术治疗,取得较好效果。     

不明原因消化道出血77例胶囊内镜检查结果分析

不明原因消化道出血指经过胃镜和结肠镜检查后病因仍未明确的,持续或反复发作的消化道出血,主要是由于小肠病变所致。由于解剖特点和检测手段的限制,不明原因消化道出血的诊断（尤其是小肠病变）一直是消化科医生面临的难题。笔者对我院2009年3月至2013年11月,门诊或住院的不明原因消化道出血患者77例的胶囊内镜检查结果进行回顾性分析,以了解其对不明原因消化道出血的诊断价值。     

内镜在消化道出血探查术中的临床应用效果评价

目的 分析内镜在消化道出血探查术中的临床应用效果.方法 选取2010年4月-2012年9月因不明原因消化道出血入我院治疗的患者80例为研究对象进行回顾性分析.应用内镜实施剖腹探查术,辅助临床诊断和治疗.结果 患者均顺利完成诊断,明确出血原因和部位,检出率为100%,其中消化道息肉64例,溃疡出血16例.所有患者顺利止血、实施手术,均康复出院.结论 对于原因不明的消化道出血患者,应用内镜实施探查术能够明确诊断患者出血部位、病变情况,减少临床诊断与治疗的盲目性,对于提升患者预后具有积极意义.     

不明原因消化道出血综合治疗临床体会

目的探讨分析不明原因消化道出血的综合治疗方法。方法观察分析近两年本院救治的不明原因消化道出血的患者33例,本院采用综合的治疗方法进行救治,通过评估分析其临床疗效探讨综合治疗的疗效。结果治疗不明原因消化道出血的有效率,即止血率＋好转率,达到90．91％,平均住院天数也仅13d除外未行相关检查的11例,不明原因消化道出血的病因中消化道溃疡相对较多,占45．45％,经检查后原因不明的也占了相对的比例。结论本院采用的综合治疗方法起到了有效的治疗和减轻患者医疗负担的效果。     

肠镜检查确诊消化道出血的临床分析

目的：对原因不明的消化道出血诊断中肠镜检查的应用方法及应用效果进行分析。方法选取消化道出血患者168例,所有患者均进行肠镜检查。结果经肠镜检查,168例消化道出血患者中有157例明确病因,确诊率为93.45%。病因分别为：肠息肉65例,慢性结肠炎症37例,大肠癌32例,血管畸形4例,溃疡性结肠炎10例,肛裂、痔9例。病灶位置：乙状结肠46例,直肠64例,回盲肠11例,降结肠17例,横结肠7例,升结肠12例。结论现阶段肠镜检查是消化道出血确诊的主要诊断技术之一,利用这一检查技术可对消化道出血原因加以明确,促使疾病检出率大幅提高,值得在临床中推广。     

腹腔镜下治疗小儿小肠出血18例效果观察

目的:探讨腹腔镜诊断和治疗儿童下消化道出血的临床价值.方法:对18例术前不明原因下消化道出血,怀疑小肠病变的患儿行腹腔镜探查术,15例确诊后14例经右下腹延伸小切口,提出肠管在腹腔外手术,1例免于手术;3例病因不明.结果:14例患儿均无中转开腹手术,手术时间40～90 min,平均75 min.术后5～10 d出院,无任何并发症.结论:小儿腹腔镜具有创伤小、安全可靠、诊断率高等特点,可替代剖腹探查术,适用于不明原因的儿童下消化道出血病例,尤其怀疑小肠出血.     

肠镜检查确诊的消化道出血临床探讨

目的探讨不明原因消化道出血诊断中采用肠镜检查的应用效果。方法 82例消化道出血患者,均采用肠镜检查,以此明确出血原因及病灶。结果 82例患者中,77例患者明确消化道出血原因,主要为慢性结肠炎症、肠息肉、溃疡性结肠炎、血管畸形、肛裂、大肠癌,例数分别为19例(24.68%)、33例(42.86%)、6例(7.79%)、3例(3.90%)、4例(5.19%)、12例(15.58%),病灶部位分别为直肠、乙状结肠、回盲肠、降结肠、横结肠。结论肠镜检查是临床中常用的消化道出血诊断方法 ,其可有效明确消化道出血病因,提升消化道出血检出率,具有较高临床推广价值。     

下消化道出血急诊剖腹探查术中内镜的应用体会

目的 探讨下消化道出血的术中内镜的临床价值.方法 回顾性分析南昌大学第一附属医院2017年1月至2020年11月行急诊剖腹探查术结合术中内镜检查的36例患者临床资料.结果 36例患者均明确诊断出血部位及出血原因,经手术等治疗均痊愈出院;随访均无再出血及死亡病例.结论 手术结合术中内镜检查对不明原因的下消化道出血患者对明确出血部位及止血是安全并且是非常有效的手段.     

不明原因消化道出血综合治疗的临床特点

不明原因消化道出血（obscure gastrointestinal bleeding,OGIB）是指由于多方面因素影响而未能检查出出血原因的消化道出血,其特点为反复性和持续性,可分为两类：①不明原因显性出血（反复便血）;②不明原因隐性出血（反复缺铁性贫血和反复粪便隐血实验阳性）.其临床表现为呕血、粪便呈现不正常黑色红色.本文对50例不明原因消化道出血患者的临床治疗资料进行分析研究.     

经肠镜检查确诊的消化道出血临床分析

目的探讨经肠镜检查确诊的消化道出血的临床经验。方法采用结肠镜进行检查,非急诊肠镜常规口服20%甘露醇250ml,清洁肠道后进行检查,除因新生物致肠腔狭窄不能继续插镜外,均插至回盲部或明确出血部位。急诊肠镜情况允许做适当的肠道清洁。其余不做导泻和灌肠,检查时反复从活检钳道内冲水及吸引肠腔内积血,并缓慢进镜,直到发现出血灶为止。结果本组260例因下消化道出血者行结肠镜检查,明确病病因者有245例。病因：溃疡性结肠炎（溃结）、直肠炎103例,肛裂、痔35例,慢性结肠炎症35例,大肠癌32例,大肠息肉40例,病因不明15例。病灶部位：位于直肠135例,乙状结肠85例,降结肠15例,横结肠10例,升结肠7例,回盲肠2例,肛管疾患6例。结论下消化道出血原因较多,行结肠镜检有助于明确下消化道出血的原因,以提高对消化道出血病因诊断。     

不明原因消化道出血的诊断进展

不明原因消化道出血临床并不少见,占消化道出血的3%～5%,明确诊断比较困难,目前仍然是消化系统疾病中研究的热点及难点。但近年来,随着内镜及放射学科的发展,使不明原因消化道出血诊治水平得以提高。本文对该病目前的认识、诊断、治疗以及所面临的问题进行了综述和讨论。     

消化胶囊内镜对不明原因消化道出血的临床分析

目的探讨消化胶囊内镜对不明原因消化道出血的临床诊断价值。方法选择我院2009年12月至2011年12月不明原因消化道出血患者共70例,上述患者均行消化胶囊内镜检查。结果胶囊内镜通过幽门时间为(56.3±4.9)min;胶囊内镜在小肠内检查时间为(294.1±39.4)min;胶囊内镜在体内工作时间为(534.4±40.7)min。本组70例患者中,38例患者检出病变,病变检出率为54.3%。其中13例患者有两种以上病变。结论胶囊内镜能够较好的对不明原因消化道出血相关病因做出诊断,诊断价值高,且安全,患者痛苦少。     

术中内镜在诊治不明原因消化道出血的作用(附21例分析)

目的研究术中内镜在剖腹探查不明原因消化道出血的价值。方法对2005年至2011年我院因小肠出血不能确诊需剖腹探查的21例患者进行了术中内镜检查,并对出血原因进行分析和评估。结果本组21例患者通过术中内镜检查全部明确出血原因和部位;术后21例未见再出血。结论在诊治不明原因消化道出血而行剖腹探查术时应配合术中内镜,可提高病变检出率,定位、定性准确,安全快速。     

胶囊内镜对不明原因消化道出血病因诊断的初步探讨

目的初步评价胶囊内镜对不明原因消化道出血的诊断价值。方法分析2003年6月至2004年12月间21例不明原因消化道出血行胶囊内镜检查的结果。结果21例行胶囊内镜检查,肠道血管畸形9例,空肠平滑肌瘤1例,小肠克罗恩病1例,小肠息肉2例,空肠炎症1例,阴性7例,病变检出率为66.7%(14/21例)。部分病例经手术病理证实。结论胶囊内镜安全,无创伤性,对不明原因消化道出血具有较高的诊断价值。     

Wireless capsule endoscopy in patients with obscure gastrointestinal bleeding: a comparative study with push enteroscopy

BACKGROUND: The identification and treatment of lesions located in the small intestine in obscure gastrointestinal bleeding is always a clinical challenge. AIM: To examine prospectively the diagnostic precision and the clinical efficacy of capsule endoscopy compared with push enteroscopy in obscure gastrointestinal bleeding. METHODS: Forty-two patients (22 men and 20 women) with obscure gastrointestinal bleeding (overt bleeding in 26 cases and occult blood loss with chronic anaemia in 16) and normal oesophagogastroduodenoscopy and colonoscopy were analysed. All patients were instructed to receive the capsule endoscopy and push enteroscopy was performed within the next 7 days. Both techniques were blindly performed by separate examiners. The diagnostic yield for each technique was defined as the frequency of detection of clinically relevant intestinal lesions carrying potential for bleeding. RESULTS: A bleeding site potentially related to gastrointestinal bleeding or evidence of active bleeding was identified in a greater proportion of patients using capsule endoscopy (74%; 31 of 42) than enteroscopy (19%; eight of 42) (P = 0.05). The most frequent capsule endoscopy findings were: angiodysplasia (45%), fresh blood (23%), jejunal ulcers (10%), ileal inflammatory mucosa (6%) and ileal tumour (6%). No additional intestinal diagnoses were made by enteroscopy. In seven patients (22%), the results obtained with capsule endoscopy led to a successful change in the therapeutic approach. CONCLUSIONS: Compared with push enteroscopy, capsule endoscopy increases the diagnosis yield in patients with obscure gastrointestinal bleeding, and allows modification on therapy strategy in a remarkable proportion of patients.     

Review article: The advent of capsule endoscopy--a not-so-futuristic approach to obscure gastrointestinal bleeding

Capsule endoscopy is a new, wireless, endoscopic examination of the small intestine. To date, two small clinical trials have been reported utilizing capsule endoscopy in patients with obscure gastrointestinal bleeding, and have shown its superiority to push enteroscopy in diagnosing the cause of blood loss. No outcome studies have been reported. This paper proposes a change in practice guidelines for obscure bleeding. It is our opinion that, in the future, with the advent of wireless capsule endoscopy, the evaluation of patients with obscure gastrointestinal bleeding will be very different from the practice of medicine today. We believe that capsule endoscopy will become the first-line method for the evaluation of patients with obscure bleeding, once upper endoscopy and colonoscopy have been shown to be negative. In patients with active bleeding, capsule endoscopy will confirm the small bowel as the site of bleeding, providing a location, or, if the study is negative for the small intestine, may indicate that the bleeding is either colonic or gastric in origin. In a patient with active bleeding within the small intestine, the capsule will guide further evaluation and therapy. A patient with a small bowel tumour detected by capsule endoscopy will proceed directly to laparoscopic surgery. If the site of bleeding is identified in the proximal small bowel and there is no mass, push enteroscopy will be used to re-identify the site and cauterize it. A distal small bowel site will require surgical intervention, coupled with intra-operative enteroscopy. Should the patient be too sick to undergo surgery, medical therapy utilizing hormonal agents will be considered. A colonic site will be evaluated by colonoscopy. In patients with a more occult or intermittent type of bleeding and in those whose upper endoscopies and colonoscopies are negative, capsule endoscopy will be used similarly to identify a bleeding lesion and thereby direct subsequent testing or treatment.     

胶囊内镜诊断不明原因消化道出血42例的临床分析

目的探讨胶囊内镜在诊断不明原因消化道出血患者中的临床价值。方法分析本院2009年4月至2012年12月间42例不明原因消化道出血患者行胶囊内镜检查的临床资料。结果 42例患者顺利完成检查,共检出病变37例,阳性检出率为88%。包括血管畸形27例,小肠间质瘤1例,新鲜出血3例,小肠溃疡4例,小肠多发异常隆起1例,小肠钩虫病3例,小肠憩室1例,非特异性炎症11例,其中14例患者同时存在2种病变。胶囊内镜检查中无任何不适和并发症。结论胶囊内镜应用于临床以来,能够较好的对不明原因消化道出血相关病因做出诊断,其安全性高、顺应性好,并已成为诊断小肠疾病的重要手段。     

Review article: the diagnosis and investigation of obscure gastrointestinal bleeding

Aliment Pharmacol Ther 2011; 34: 416–423

Summary

Background Obscure gastrointestinal bleeding (OGIB) is a commonly encountered clinical problem in gastroenterology and is associated with significant morbidity and mortality. The investigation and management of OGIB has changed dramatically over the past decade with the advent of newer gastroenterological and radiological technologies. Aim To review the current evidence on the diagnosis and investigation of OGIB. Methods We searched the PubMed database (1985–2010) for full original articles in English‐language journals relevant to the investigation of OGIB. The search terms we used were ‘gastrointestinal bleeding’ or ‘gastrointestinal hemorrhage’ or ‘small bowel bleeding’ each in combination with ‘obscure’, or ‘capsule endoscopy’, or ‘enteroscopy’ or ‘enterography’ or ‘enteroclysis’. Results Capsule endoscopy (CE) or double balloon enteroscopy (DBE) should be first line investigations. They are complimentary procedures with comparable high diagnostic yields. DBE is also able to provide therapeutic intervention. Newer technologies such as single balloon and spiral enteroscopy are currently being evaluated. Radiological and nuclear medicine investigations, such as CT enterography and CT enteroclysis, are alternative diagnostic tools when CE or DBE are contraindicated. Repeating the gastroscopy and/or colonoscopy may be considered in selective situations. An algorithm for investigation of obscure bleeding is proposed. Conclusions The development of capsule endoscopy and double balloon enteroscopy has transformed the approach to the evaluation and management of obscure gastrointestinal bleeding over the past decade. Older diagnostic modalities still play a complementary, but increasingly selective role.     

双气囊小肠镜诊断不明原因消化道出血

目的：评估双气囊小肠镜对不明原囚消化道出（OGIB）的诊断价值。方法：在麻醉辅助下对96例OGIB患者施行双气囊小肠镜检查。结果：小肠溃疡27例,非特异性炎症11例,钩虫病8例,息肉病7例,血管畸形7例,憩室病5例（其中美克尔憩室3例）,克罗恩病6例,间质瘤4例,高分化腺癌3例,十二指肠溃疡2例,蛔虫1例。结论：双气囊小肠镜是诊断OGIB的一种有效、安全的检查手段。