单气囊小肠镜对小肠出血的诊断价值

刘礼剑 郑超伟 韦金秀 陈然 王兴丽 于福富 黎霞 覃梦琦 卢杰夫

【摘要】 目的 探討单气囊小肠镜对小肠出血病因诊断的价值。

方法 回顾性分析2014年1月～2019年12月拟诊小肠出血并经单气囊小肠镜检查的36例患者，其中男22例，女14例，年龄（38±12）岁，所有患者均经胃镜、结肠镜检查后未明确出血病灶。其中16例解黑便者先予经口进镜，有5例再经肛进镜;20例解暗红色或红色血便者先予经肛进镜，有4例再经口进镜。

结果 在36例患者中，有32例经单气囊小肠镜检查后明确出血病因，占88.9%（32/36）。其中小肠麦克尔憩室9例，占28.12%;小肠血管畸形7例，占21.88%;小肠间质瘤7例，占21.88%;十二指肠降部以下部位溃疡4例，占12.5%;克罗恩病3例，占9.38%;小肠恶性淋巴瘤2例，占6.25%。

结论 单气囊小肠镜对小肠出血的病因诊断具有重要价值。

【关键词】 单气囊小肠镜;不明原因消化道出血;小肠出血;诊断

中图分类号：R574.5   文献标志码：A   DOI：10.3969/j.issn.1003-1383.2021.04.005

Value of single balloon enteroscopy in the diagnosis of small intestinal bleeding

LIU Lijian1， ZHENG Chaowei1， WEI Jinxiu1， CHEN Ran1， WANG Xingli1， YU Fufu1， LI Xia1， QIN Mengqi1， LU Jiefu2

（1. Digestive Endoscopy Center， The First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine， Nanning 530023， Guangxi， China; 2. Department of Gastroenterology， Nanning First People' s Hospital， Nanning 530022， Guangxi， China）

【Abstract】 Objective To explore the value of single balloon enteroscopy in the diagnosis of the cause of small intestinal bleeding.

Methods From January 2014 to December 2019， 36 patients with suspected small intestinal bleeding who underwent single balloon enteroscopy were retrospectively analyzed， including 22 males and 14 females， aged （38±12） years. All patients were examined by gastroscope and colonoscopy， and no bleeding lesions were found. Among them， 16 patients who resolved black stool were first given enteroscopy through the mouth， and 5 patients were then through the anus; 20 patients who resolved dark red or red bloody stool were first through the anus， and 4 patients were then through the mouth.

Results Of the 36 patients， the causes of bleeding in 32 cases were confirmed by single balloon enteroscopy， accounting for 88.9%（32/36）. Among them， small intestinal Meckel's diverticulums were found in 9 cases， accounting for 28.12%; small intestinal vascular malformations were found in 7 cases， accounting for 21.88%; small intestinal stromal tumors were found in 7 cases， accounting for 21.88%; ulcers below the descending segment of the duodenum were found in 4 cases， accounting for 12.5%; Crohn's diseases were found in 3 cases， accounting for 9.38%; small intestinal malignant lymphomas were found in 2 cases， accounting for 6.25%.

Conclusion Single balloon enteroscopy is of great value in the diagnosis of the cause of small bowel bleeding.

【Key words】 single balloon enteroscopy; unexplained gastrointestinal bleeding; small intestinal bleeding; diagnosis

消化道出血是消化系统最常见的危重病之一，随着内镜技术的发展，越来越多的消化道出血病因被明确，但在很长一段时间内小肠是作为消化道盲区而存在[1]。随着胶囊内镜，特别是小肠镜技术的开展和普及，更多的小肠疾病被诊断。我院自2014年引进单气囊小肠镜[2]设备，开展此项技术已逾6年，本文通过对6年来36例拟诊小肠出血并行单气囊小肠镜检查患者行回顾性研究，以初步探讨单气囊小肠镜对小肠出血的诊断价值。

1 资料与方法

1.1 病例资料

2014年1月至2019年12月期间初步诊断为不明原因消化道出血，并行单气囊小肠镜检查，共36例患者。……