小肠出血的临床分析

目的探讨小肠出血的病因和诊疗方法。方法回顾性分析45例小肠出血的临床资料。结果肿瘤21例(46.6%),以良性肿瘤多见;炎性疾病7例(15.5%);憩室9例(20.0%);血管畸形6例(13.3%);肠系膜上动脉栓塞2例(4.4%)。各种检查的阳性率:核素扫描23.0%,选择性肠系膜血管造影64.3%,小肠气钡双重造影31.8%。术后再出血3例,短肠综合征1例。结论小肠出血以肿瘤最常见,憩室也是常见的发病因素;选择性血管造影对血管病变及富含血管的肿瘤有较高的诊断价值,核素扫描对有明显出血但循环平稳的病人是理想的诊断方法,小肠气钡双重造影对实质性病变及憩室的诊断率较高;包括病变在内的小肠部分切除术是治疗小肠出血最有效方法。

Clinical study on diagnosis and treatment of small intestinal hemorrhage

Objective To investigate the etiopathogenisis,diagnostic methods and therapy of small intestinal hemorrhage.Methods Clinical data of forty-five cases of small intestinal hemorrhage were analyzed retrospectively.Results Small intestinal tumors were found in 21 cases(46.6 %),most of them were benign,inflammatory diseases in 7 cases(15.5 %);diverticula in 9 cases(20.0 %);vascular malformations in 6 cases(13.3%);superior mesenteric artery embolus(SMAE)in 2 cases.Radionuclide scanning was positive in 3 out of 13 cases(23.0 %).Angiography was performed in 14,9 of them were abnormal(64.3%).Double-contrast barium meal made diagnosis in 31.8 % of 22 cases.Postoperative bleeding was found in 3cases and short bowel syndrome in 1 case.Conclusion Tumors are the most common cause of small bowel bleeding,diverticula are also occurrent frequently.Angiography is a valuable procedure in diagnosis of vascular lesions and malignants.Radionuclide scanning is suitable for patients which suffer from obviously hemorrhage with steady circulation.Double-contrast barium meal is also helpful in diagnosis of solid lesions and diverticula's.Exploratory surgery coupled with intraoperative endoscopy can be helpful in diagnosis of small bowel bleeding.