空回肠出血诊断分析

目的 :探讨空回肠出血的病因及诊断方法的选择。方法 :33例空回肠出血患者分别行胃镜、结肠镜、全消化道钡餐、核素扫描、血管造影、剖腹探查及术中肠镜等单项或多项检查 ,手术及病检证实。结果 :33例患者中 ,小肠肿瘤占 13例 (39 39% ) ,以平滑肌瘤多见 ,小肠感染性疾病 8例 (2 4 2 4% ) ,Meckel’s憩室 7例 (2 1 2 1% ) ,血管病变(包括血管瘤 ) 3例 (9 1% ) ,其它 2例 (6 0 6 % )。其临床表现为不同程度的消化道出血 ,黑便多见 (4 2 42 % ) ,约 1/ 3的患者伴有腹痛 ,以中度贫血为多见 (4 8 48% )。核素扫描检查 7例 ,5例均发现小肠出血部位 ,经手术和病理检查证实均为Meckel’s憩室 ;胃镜和 /或结肠镜检查 2 0例 ,5例提示小肠病变 ;剖腹探查 6例 ,其中 1例蓝色橡皮疱痣血管瘤、1例血管畸形、1例坏死性小肠炎 ,3例经术中肠镜发现 1例副伤寒、1例空肠平滑肌瘤、1例肠道钩虫病。结论 :空回肠出血以肿瘤为最常见病因 ,对不明原因的中度贫血伴黑便者应高度怀疑小肠病变 ,核素检查对诊断Meckel’s憩室阳性率高。

Study on Diagnosis of small intestinal hemorrhage

TO explore the etiology and different methods of diagnosis for 33 cases of small intestinal hemorrhage, which were confirmed by surgery and/or pathology. Methods: 33 cases of small intestinal hemorrhage were diagnosed by endoscopy, barium studies, radionucleotide scanning, angiograpy, exploratory laparotomy and intraoperative colonscopy, which were confirmed by surgery and/or pathology. Results: Small intestinal tumors were found in 13 cases (39.39%), Leiomyoma in 8; infectious diseases in 8(24.24%); Meckel's diverticulum in 7(21.21%); and vascular malformation in 3(9.1%) and others in 2(6.06%). Among them, black stool (42.42%) is the most commonly seen. The common clinical presentation was middle anemia and patients with unexplained abdominal pain (36.36%). Radionucleotide scanning was positive in 5 out of 7 cases, and all of five were Meckel's diverticulum. Endoscopy revealed 5 out of 20 cases. Exploratory laparotomy was performed in 6, 3 were found to have some lesions, and the other 3 were diagnosed by intraoperative colonscopy. Conclusions: Tumor is the nost common cause of small intestinal hemorrhage, mied anemia and black stool are the common clinical presentations, Radionucleotide scanning is one of the most useful diagnostic methods for Meckel's diverticulum and intraoperative colonscopy could elevate veracity of diagnosis. [