常见小肠出血的原因分析及诊治体会

目的 分析总结常见小肠出血病因及诊治经验。方法 对1990-2004年第四军医大学西京医院普三科诊治的74例经手术及病理证实小肠出血的临床资料进行回顾性分析。结果 小肠出血发生原因依次分别为肿瘤（41.9%）、小肠憩室（25.7%）、血管病变（23.0%)及炎性肠病（9.5%）。＞45岁病人以肿瘤（55.6%）、血管病变（27.8%）为主，≤45岁以小肠憩室（42.1%）和肿瘤（28.9%）为主。全组病人均经手术治疗。结论 肿瘤是引起小肠出血的主要原因，其次为小肠憩室、炎性肠病及血管病变。选择性肠系膜血管造影、核素扫描和小肠气钡双重造影是小肠出血的主要诊断方法，对怀疑小肠出血，辅助检查无法明确诊断时剖腹探查是主要诊断方法。针对不同原因的小肠出血可以选择药物、内镜或手术治疗。

Diagnosis and analysis of causes of small intestinal bleeding

Diagnosis and analysis of causes of small intestinal bleeding WANG Ting, WANG Ling LING Rui, et al. Department of Vascular Surgery, XI JING Hospital, the Fourth Military Medical University, Xi’an 710032, China Corresponding author：WANG Ting, E-mail：ting_w100@126.com Abstract Objective To summarize the diagnosis and treatment experiences and causes of small intestinal bleeding. Methods The clinical data of 74 cases of small intestinal bleeding admitted between 1990 and 2004 in the No 3 Department of General Surgery, XI JING Hospital of the Fourth Military Medical University were analyzed retrospectively. The causes of bleeding in all the cases were confirmed by surgery and pathology. Results The main cause of small intestinal hemorrhage was tumor (41.9%), while the other causes in turn were small intestinal diverticulum (25.7%), vasculopathy (23.0%), and inflammatory small intestinal diseases (9.5%). But to young cases (≤45), the main causes of small intestinal hemorrhage were small intestinal diverticulum (42.1%) and tumor (28.9%), while they were tumor (55.6%) and vasculopathy (27.8%) to aged cases (＞45). All the cases were treated by operation. Conclusion Tumor is the most common cause of small intestinal bleeding. Other causes are small intestinal diverticulum, inflammatory small intestinal diseases and angiodysplasia. The double-contrast barium meal, angiography and radionucleide scanning were the main diagnostic methods for small intestinal bleeding. Abdominal laparotomy was also a diagnostic method if the results of auxiliary examinations were negative.