小肠出血诊断方法的探讨

目的 :探讨小肠出血的诊断方法。　方法 :对 71例经小肠钡剂造影、小肠镜、血管造影、核素显像和经手术病理证实的小肠出血的病因进行分析。　结果 :小肠出血以小肠肿瘤居首位 ,占 5 2 .1% (37/71) ,良性肿瘤占32 .4 % (2 3/71) ,恶性肿瘤占 19.7% (14 /71) ,病变部位以空肠多发。其次为血管发育不良占 2 9.6 % (2 1/71) ,病变多位于末端回肠。克罗恩病占 8.5 % (6 /71)。手术探查阳性率为 97.2 % (6 9/71) ,血管造影阳性率为 81.7% (49/6 0 ) ,核素显像阳性率为 72 .7% (8/11) ,小肠镜检查阳性率为 31.4 % (11/35 ) ,全消化道钡剂造影阳性率为 12 % (6 /49)。　结论 :肿瘤是小肠出血的首要原因 ,其次为血管发育不良 ,血管造影对小肠肿瘤及血管发育不良诊断率较高 ,及时手术探查对小肠出血具有诊断和治疗的双重作用

Study on the diagnosis of small intestinal hemorrhage

Objectives: To assess the diagnostic value of enteroclysis, endoscopy, DSA, ECT and surgery in the diagnosis of small intestinal bleeding. Methods: The causes of 71 cases of small intestinal bleeding confirmed by enteroclysis, endoscopy, DSA, ECT and surgery were analysed. Results: Small intestinal tumors, especially located in jejunum, were found in 37 cases (52.1%). In these tumor cases, 32.4% (23 cases) were benign neoplasms, 19.7% (14 cases) were malignancies. The next common causes were angiodysplasia, generally located in ileum, and Crohn's disease,accounting for 29.6% (21 cases) and 8.5% (6 cases) respectively. The positive findings of each diagnostic method were exploratory laparotomy in 97.2% (69/71cases), angiography(DSA) in 81.7% (49/60cases), emission computed tomagraphy (ECT) in 72.7% (8/11cases) , endoscopy in 31.4% (11/35cases) and enteroclysis 12% (6/49cases) respectively. Conclusions:Tumor is the most common cause of small intestinal bleeding, and angiodysplasia is the second, with a high morbidity rate also. DSA is one of the most useful diagnostic procedures. Exploratory laparotomy has a dual significance both in the diagnosis and treatment of the diseases.