小肠出血病因临床诊断及治疗

目的总结小肠出血的病因、临床表现、诊断及治疗经验。方法回顾性分析1995年1月～2009年9月北京大学第三医院普外科收治的35例小肠出血患者的病因、临床表现、诊断及治疗。结果除出血表现外,62.9%(22/35)不伴其他症状,85.7%(30/35)不伴腹部阳性体征。35例均伴有贫血,其中急性大出血4例,慢性显性出血29例,慢性隐性出血2例。入院时血红蛋白中位数67g/L(30～108g/L)。入院时合并失血性休克4例(11.4%)。小肠肿瘤占37.1%(13/35),其次为小肠憩室31.4%(11/35),小肠炎症22.9%(8/35),血管疾病8.6%(3/35)。2例行内镜下止血治疗;33例外科手术治疗(28例行小肠部分切除肠吻合术,5例行腹腔镜下憩室局部切除),其中开腹手术19例,腹腔镜手术14例。术中肠镜7例。结论小肠出血的症状与体征无特异性,小肠肿瘤、小肠憩室、小肠炎症是小肠出血常见原因。术中肠镜检查为最后诊断隐匿性小肠出血的有效方法。外科手术治疗是治疗小肠出血最有效的方法 。

Diagnosis and Treatment of Small Intestinal Bleeding

Objective To investigate the causes, clinical manifestations, diagnosis and treatment of small intestinal bleeding. Methods From January 1995 to September 2009, totally 35 cases of small intestine bleeding confirmed by surgery and postoperative pathology were admitted in our hospital. The clinical data of the patients, including the causes, manifestations, diagnosis, and therapeutic methods, were analyzed retrospectively. Results Among the 35 patients, 62.9% （22/35） of them showed no accompanying symptoms, and 85.7% （30/35） had no abdominal signs. All the patients showed anemia, including hemorrhagic shock in 4 patients, chronic visible bleeding in 29 patients, and chronic occult bleeding in 2 cases. On admission, the medium level of hemoglobin of the patients was 67 g/L （ranged from 30 to 108 g/L）, four of them （11.4%） had hemorrhagic shock. Intestinal tumor accounts for 37.1% （13/35） of the patients, followed by intestine diverticulum （31.4%, 11/35）, intestinal inflammation （22.9%, 8/35）, and angiodysplasia （8.6%, 3/ 35）. Endoscopic homeostasis was performed on 2 patients, and surgical treatment was carried out in the other 33 cases, including 28 cases of partial resection of the intestine combined with intestinal anastomosis, and 5 cases of laparoscopic partial resection of the diverticulum. In the 33 patients who underwent surgical treatment, open surgery was carried out in 19 cases, and the other 14 patients received laparoscopy. During the operation, enteroscopy was used in 7 patients. Conclusions Most patients with small intestinal bleeding have no specific signs or symptoms. Neoplasm, intestinal diverticulum and inflammation are the most common causes for small intestinal bleeding. Intraoperative enteroscopy provides promising method in diagnosing occult small intestinal bleeding.