本文關鍵詞： 下消化道出血 病因 診療策略　出處：《山東大學》2016年碩士論文　論文類型：學位論文

【摘要】：目的：探討下消化道出血的病因構成及其在不同年齡段及性別的分布特點,分析每種疾病的疾病特點和診療思路,并對不明原因的下消化道出血的不同檢查方法進行比較。方法：收集2011年1月1日至2016年3月1日于山東省立醫(yī)院消化內科住院治療并確診為下消化道出血的患者,通過一系列檢查手段明確下消化道出血的病因及部位,通過胃鏡檢查排除上消化道出血,并剔除資料不全、未經系統(tǒng)檢查自動出院的患者。選取其中檢查資料相對完善共244例患者的臨床資料進行回顧性統(tǒng)計分析。根據(jù)性別分男女兩組,根據(jù)年齡分為青年組、中年組、老年組,分別分析各組之間病因分布有無差異。分析總結不同疾病的診斷方法及主要治療手段,并比較分析不同檢查手段對于小腸出血的檢出率。結果：1.本次收住的下消化道出血病例中,按照出血分類,依次為腸道感染或炎癥(35.6%),結直腸息肉(20.9%),結直腸癌(17.2%),血管病變(9.8%),,痔瘡(7.0%),腸道憩室(6.1%),不明原因的小腸出血(4.1%),小腸腫瘤(2.9%)及過敏性紫癜(0.4%),前五位分別是腸道感染或炎癥,結直腸息肉,結直腸癌,血管病變,痔瘡。2.發(fā)生下消化道出血的年齡組中以老年組最多,其次是中年組。對于下消化道出血的發(fā)病人數(shù)中,青年組與中年、老年組有明顯統(tǒng)計學差異(P0.05),而中年組與老年組無明顯統(tǒng)計學差異(P0.05)。不同年齡組的疾病種類分布情況不同,老年組結直腸癌所占比例最高(28.8%),青年組及中年組腸道感染或炎癥所占比例最高,分別為56.4%,30.0%。3.發(fā)生下消化道出血的男性患者(52.02%)多于女性患者(47.98%),但無明顯統(tǒng)計學差異(p0,05)。4.在下消化道出血的診斷過程中,不同病因、不同發(fā)病部位的疾病需要的檢查手段不同,結直腸病變主要通過結腸鏡檢查及病理學檢查診斷,必要情況下可輔以CT檢查,小腸出血在行胃鏡檢查及結腸鏡檢查排除上消化道出血或結直腸出血的前提下,可根據(jù)具體情況行膠囊內鏡檢查、小腸鏡檢查、小腸造影、CT檢查、DSA、放射性核素檢查及術中腸鏡或剖腹探查。結論：1.本文中下消化道出血的病因依次為腸道炎癥、結直腸息肉、結直腸癌、血管病變、腸道潰瘍、痔瘡、腸道憩室、不明原因的消化道出血、小腸腫瘤、過敏性紫癜。2.下消化道出血病因分布在不同年齡組有差異。青年組及中年組下消化道出血的最主要病因為腸道感染或炎癥,而老年組主要是結直腸癌出血。下消化道出血病因分布性別間無明顯差異。3.不同發(fā)病部位、不同病種的疾病所需的檢查手段不同,結腸鏡是各種下消化道出血病因診斷的首要檢查手段。
[Abstract]:Objective: to investigate the etiology of lower gastrointestinal bleeding and its distribution in different ages and sexes, and to analyze the disease characteristics and diagnosis and treatment of each disease. Methods: from January 1st 2011 to March 1st 2016, the patients who were hospitalized in the Department of Digestive Medicine of Shandong Provincial Hospital and diagnosed as lower gastrointestinal bleeding were compared. The etiology and location of lower gastrointestinal bleeding were determined by a series of examination methods, the upper gastrointestinal bleeding was excluded by gastroscopy, and the incomplete data were eliminated. The clinical data of 244 patients without systematic examination were analyzed retrospectively. According to sex, the patients were divided into three groups: youth group, middle age group, old age group, young group, middle age group, old age group, male and female groups. The etiology and distribution of each group were analyzed, and the diagnostic methods and main treatment methods of different diseases were analyzed and summarized. The detection rate of small intestinal hemorrhage by different examination methods was compared and analyzed. Results: 1. Among the cases of hemorrhage of lower digestive tract, the cases were classified according to bleeding. The order is intestinal infection or inflammation (35.6m), colorectal polyp (20.9m), colorectal cancer (17.2C), vascular lesion (9.8C), hemorrhoids (7.0cm), intestinal diverticulum (6.1g), intestinal hemorrhage for unknown reasons (4.1g) and intestinal tumor (2.9C) and allergic purpura (0.40.4C). The first five are intestinal infection or inflammation, colorectal polyps, colorectal polyps. Colorectal cancer, angiopathy, hemorrhoids. 2. In the age group with lower gastrointestinal bleeding, the elderly group was the most common, followed by the middle age group. There was significant statistical difference between the old group and the middle age group (P 0.05), but there was no significant difference between the middle age group and the old group (P 0.05). The proportion of colorectal cancer in the elderly group was the highest (28.8%), and the proportion of intestinal infection or inflammation was the highest in the young group and the middle-aged group. The number of male patients with lower gastrointestinal bleeding was 52.02cm) more than that of female patients (47.98g), but there was no significant difference between them. In the process of diagnosis of lower gastrointestinal hemorrhage, different etiology and different diseased sites required different examination methods. Colorectal lesions are mainly diagnosed by colonoscopy and pathology, and can be supplemented by CT if necessary. Intestinal hemorrhage is excluded from upper gastrointestinal bleeding or colorectal bleeding by gastroscopy and colonoscopy. Capsule endoscopy, enteroscopy, CT examination of small intestine, radionuclide, colonoscopy or laparotomy can be performed according to specific conditions. Conclusion 1. The causes of lower gastrointestinal bleeding in this paper are intestinal inflammation, colorectal polyps, and colorectal polyps, respectively. Colorectal cancer, vascular lesions, intestinal ulcers, hemorrhoids, intestinal diverticulum, unknown gastrointestinal bleeding, small intestinal tumors, The etiology of lower gastrointestinal bleeding is different in different age groups. The main cause of lower gastrointestinal bleeding in young and middle-aged groups is intestinal infection or inflammation. In the elderly group, there was no significant difference in the etiological distribution of lower gastrointestinal bleeding. 3. Different disease sites and different diseases required different examination methods. Colonoscopy is the primary method for the diagnosis of all kinds of lower gastrointestinal bleeding.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R574

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