80例小腸疾病臨床分析
發(fā)布時間：2018-11-01 19:47
【摘要】：研究目的:由于小腸其特殊的解剖特點,癥狀也缺乏特異性,使小腸疾病一直是檢查的難點。通過回顧性分析天津醫(yī)科大學(xué)第二醫(yī)院近6年確診小腸疾病的80例病例,分析小腸疾病的臨床表現(xiàn)、診斷及檢查方法,探討我院小腸疾病的臨床特征及我院三種主要檢查方法的應(yīng)用價值,從而增加對小腸疾病的認(rèn)識,提高對其診斷率。研究方法:納入自2009年11月至2016年3月就診于天津醫(yī)科大學(xué)第二醫(yī)院的80例住院患者,這些患者經(jīng)臨床診斷(包括癥狀、體征、實驗室檢查)、影像學(xué)診斷(膠囊內(nèi)鏡、消化道X線造影、口服法多層螺旋CT小腸造影)、手術(shù)病理已確診小腸疾病。分析他們的臨床表現(xiàn)、診斷及檢查方法。比較消化道X線小腸造影、多層螺旋CT小腸造影、膠囊內(nèi)鏡三種主要的檢查方法對于小腸疾病總的檢出率、確診率。并根據(jù)小腸檢查的不同適應(yīng)癥,分析我院三種小腸檢查方法的檢出率和診斷價值。結(jié)果:1.80例小腸疾病的患者中,男性42例,女性38例,男女比為1.11:1,平均年齡52.32歲。臨床表現(xiàn)為腹痛的有54例(67.5%),腹部包塊42例(52.5%),貧血25例(31.25%),消化道出血35例(43.75%),消瘦33例(41.25%),腹脹11例(13.75%),腹瀉8例(10%),食欲不振17例(21.25%),發(fā)熱7例(8.75%)。2.80例小腸疾病患者中共包括腫瘤40例,占小腸疾病的大多數(shù)(50%),分別為小腸腺癌17例,間質(zhì)瘤16例,淋巴瘤7例,腫瘤中以腺癌(17例,占42.5%)和間質(zhì)瘤(16例,占40%)為主;另有炎癥性疾病16例(20%),包括克羅恩病5例,非特異性炎癥11例;還有血管畸形10例,憩室14例。3.80例患者中,消化道X線鋇劑造影檢查共20例,檢出率為25%(5/20),確診率為10%(2/20)。多層螺旋CT小腸造影檢查共57例,檢出率為80.70%(46/57),確診率為52.63%(30/57)。膠囊內(nèi)鏡檢查共41例,檢出率為70.73%(29/41),確診率為56.10%(23/41)。多層螺旋CT小腸造影的檢出率最高,其次為膠囊內(nèi)鏡,消化道X線鋇劑造影的檢出率最低,差別均有統(tǒng)計學(xué)意義(P0.05)。在確診率上,消化道X線鋇劑造影的確診率最低,而膠囊內(nèi)鏡和多層螺旋CT小腸造影的確診率相對較高,且無明顯差異(P0.05)。4.35例不明原因消化道出血患者的病因分別為非特異性炎癥9例,克羅恩病3例,血管畸形10例,腺癌4例,淋巴瘤1例,間質(zhì)瘤3例,憩室5例。其中炎癥最多(12/35,34.29%),其次為血管性病變(10/35,28.57%),腫瘤最少(8/35,22.86%)。對于不明原因消化道出血患者,膠囊內(nèi)鏡診斷的陽性檢出率72.41%(21/29)明顯高于多層螺旋CT小腸造影52%(13/25)(P0.05),更明顯高于消化道X線造影25%(1/4)(P0.05)。5.54例不明原因腹痛的患者共發(fā)現(xiàn)腫瘤21例(38.89%),其中小腸腺癌11例,小腸間質(zhì)瘤8例,淋巴瘤2例;炎癥性疾病16例(29.63%),其中克羅恩病3例,非特異性炎癥11例;血管畸形10例(18.52%),此外還有憩室9例。對于不明原因腹痛的病人,消化道X線造影診斷的陽性檢出率(18.18%,2/11)最低(P0.05),多層螺旋CT小腸造影與膠囊內(nèi)鏡的陽性檢出率分別為65.91%(29/44)和65.71%(23/35),差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:小腸疾病的臨床表現(xiàn)缺乏特異性,病因以炎癥性疾病及腫瘤多見,當(dāng)出現(xiàn)腹痛、腹瀉、腹部包塊、消化道出血等癥狀,經(jīng)胃鏡、腸鏡除外胃和結(jié)腸的疾病,或者胃鏡、腸鏡鏡下表現(xiàn)難以解釋時,一定要考慮到小腸疾病的可能。對小腸疾病的總體檢出率和準(zhǔn)確率,膠囊內(nèi)鏡和多層螺旋CT小腸造影均明顯高于消化道X線造影檢查。對于不明原因消化道出血的病人,膠囊內(nèi)鏡可作為首選檢查。隨著各種檢查技術(shù)的飛速發(fā)展,小腸疾病的診斷會更加完善,發(fā)現(xiàn)率會越來越高。
[Abstract]:Research purposes: Because of the special anatomical features of the small intestine, the symptom also lacks specificity, so that the small intestine disease has been the difficult point of the examination. By retrospective analysis of 80 cases of small intestinal diseases in the second hospital of Tianjin Medical University, the clinical manifestations, diagnosis and examination methods of small intestine diseases were analyzed. The clinical characteristics of small intestine diseases in our hospital and the application values of three main examination methods in our hospital were discussed. thereby increasing the cognition of small intestine diseases and improving the diagnosis rate. Methods: Eighty inpatients from November 2009 to March 2016 were admitted to the Second Hospital of Tianjin Medical University. These patients were diagnosed clinically (including symptoms, signs, laboratory examinations), imaging diagnosis (capsule endoscopy, digestive tract X-ray angiography). Multi-slice spiral CT enterography of oral method, the operation pathology has confirmed the small intestine disease. Their clinical manifestations, diagnosis and examination methods were analyzed. The diagnostic rate and rate of diagnosis of small intestine diseases were compared with X-ray small intestine angiography, multi-slice spiral CT enterography and capsule endoscopy. According to different indications of small bowel examination, the detection rate and diagnostic value of three small intestine examination methods in our hospital were analyzed. Results: Among the 80 cases of small bowel disease, 42 males and 38 females, 1. 11: 1, the average age was 52. 32 years. The clinical manifestations included 54 cases (67. 5%) of abdominal pain, 42 cases (52. 5%) of abdominal mass, 25 cases of anemia (31. 25%), 35 cases of digestive tract hemorrhage (43. 75%), wasting 33 cases (41. 25%), abdominal distention in 11 cases (13.75%), diarrhea in 8 cases (10%), and cholangitis in 17 cases (21. 25%). Of the 80 cases of small intestine disease, 40 cases were included, most (50%) of small intestine diseases, 17 cases of small intestine adenocarcinoma, 16 cases of interstitial tumor, 7 cases of lymphoma, adenocarcinoma in 17 cases (42. 5%) and interstitial tumor (16 cases, 40%). There were 16 cases (20%) of inflammatory diseases, including 5 cases of Crohn's disease, 11 cases of nonspecific inflammation, 10 cases of vascular malformation, 14 cases of non-specific inflammation, 3. Among 80 patients, 20 cases were examined by X-ray radiography and 25% (5/ 20), and the rate of diagnosis was 10% (2/ 20). 57 cases were examined by multi-slice spiral CT enterography, the positive rate was 80. 70% (46/ 57), and the rate of diagnosis was 52. 63% (30/ 57). A total of 41 cases were examined by capsule endoscopy, the positive rate was 70. 73% (29/ 41), and the rate of diagnosis was 56. 10% (23/ 41). The detection rate of multi-slice spiral CT enterography was the highest, followed by capsule endoscopy, the lowest detectable rate of X-ray imaging in digestive tract, and the difference was statistically significant (P0.05). At the rate of diagnosis, the diagnostic rate of X-ray imaging was the lowest in the digestive tract, while the diagnostic rate of the capsule endoscopy and multi-slice spiral CT enterography was relatively high, and there was no significant difference (P0.05). There were 10 cases of vascular malformation, 4 cases of adenocarcinoma, 1 case of lymphoma, 3 cases of interstitial tumor and 5 cases of adenocarcinoma. Among them, inflammation was most (12/ 35, 34. 29%), followed by vascular lesions (10/ 35, 28. 57%), with minimal tumor (8/ 35, 22. 86%). The positive rate of endoscopy was 72. 41% (21/ 29) significantly higher than that of the multi-slice spiral CT enterography (52% (13/ 25) (P0.05). There were 8 cases of interstitial tumor of small intestine, 2 cases of lymphoma, 16 cases of inflammatory disease (29. 63%), of which 3 cases of Crohn's disease, 11 cases of nonspecific inflammation, 10 cases of vascular malformation (18.52%), and 9 cases of vascular malformation. For patients with unexplained abdominal pain, the positive rate of X-ray angiography in the digestive tract (18. 18%, 2/ 11) was lowest (P0.05). The positive rates of the multi-slice spiral CT enterography and the capsule endoscopy were 65. 91% (29/ 44) and 65. 71% (23/ 35), respectively (P0.05). Conclusion: The clinical manifestation of small bowel disease is lack of specificity, the cause is inflammatory disease and tumor, when abdominal pain, diarrhea, abdominal bag block, digestive tract bleeding, etc., through gastroscope, intestinal endoscope, stomach and colon diseases, or gastroscope and enteroscopy, it is difficult to explain. The possibility of small bowel disease must be taken into account. The overall detection rate and accuracy rate of small bowel disease, capsule endoscopy and multi-slice spiral CT enterography were significantly higher than that of X-ray angiography in digestive tract. Capsule endoscopy may be preferred for patients with unknown cause of gastrointestinal bleeding. With the rapid development of various inspection techniques, the diagnosis of small bowel disease will be more complete and the rate of discovery will be higher and higher.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R574.5
本文編號：2304916
[Abstract]:Research purposes: Because of the special anatomical features of the small intestine, the symptom also lacks specificity, so that the small intestine disease has been the difficult point of the examination. By retrospective analysis of 80 cases of small intestinal diseases in the second hospital of Tianjin Medical University, the clinical manifestations, diagnosis and examination methods of small intestine diseases were analyzed. The clinical characteristics of small intestine diseases in our hospital and the application values of three main examination methods in our hospital were discussed. thereby increasing the cognition of small intestine diseases and improving the diagnosis rate. Methods: Eighty inpatients from November 2009 to March 2016 were admitted to the Second Hospital of Tianjin Medical University. These patients were diagnosed clinically (including symptoms, signs, laboratory examinations), imaging diagnosis (capsule endoscopy, digestive tract X-ray angiography). Multi-slice spiral CT enterography of oral method, the operation pathology has confirmed the small intestine disease. Their clinical manifestations, diagnosis and examination methods were analyzed. The diagnostic rate and rate of diagnosis of small intestine diseases were compared with X-ray small intestine angiography, multi-slice spiral CT enterography and capsule endoscopy. According to different indications of small bowel examination, the detection rate and diagnostic value of three small intestine examination methods in our hospital were analyzed. Results: Among the 80 cases of small bowel disease, 42 males and 38 females, 1. 11: 1, the average age was 52. 32 years. The clinical manifestations included 54 cases (67. 5%) of abdominal pain, 42 cases (52. 5%) of abdominal mass, 25 cases of anemia (31. 25%), 35 cases of digestive tract hemorrhage (43. 75%), wasting 33 cases (41. 25%), abdominal distention in 11 cases (13.75%), diarrhea in 8 cases (10%), and cholangitis in 17 cases (21. 25%). Of the 80 cases of small intestine disease, 40 cases were included, most (50%) of small intestine diseases, 17 cases of small intestine adenocarcinoma, 16 cases of interstitial tumor, 7 cases of lymphoma, adenocarcinoma in 17 cases (42. 5%) and interstitial tumor (16 cases, 40%). There were 16 cases (20%) of inflammatory diseases, including 5 cases of Crohn's disease, 11 cases of nonspecific inflammation, 10 cases of vascular malformation, 14 cases of non-specific inflammation, 3. Among 80 patients, 20 cases were examined by X-ray radiography and 25% (5/ 20), and the rate of diagnosis was 10% (2/ 20). 57 cases were examined by multi-slice spiral CT enterography, the positive rate was 80. 70% (46/ 57), and the rate of diagnosis was 52. 63% (30/ 57). A total of 41 cases were examined by capsule endoscopy, the positive rate was 70. 73% (29/ 41), and the rate of diagnosis was 56. 10% (23/ 41). The detection rate of multi-slice spiral CT enterography was the highest, followed by capsule endoscopy, the lowest detectable rate of X-ray imaging in digestive tract, and the difference was statistically significant (P0.05). At the rate of diagnosis, the diagnostic rate of X-ray imaging was the lowest in the digestive tract, while the diagnostic rate of the capsule endoscopy and multi-slice spiral CT enterography was relatively high, and there was no significant difference (P0.05). There were 10 cases of vascular malformation, 4 cases of adenocarcinoma, 1 case of lymphoma, 3 cases of interstitial tumor and 5 cases of adenocarcinoma. Among them, inflammation was most (12/ 35, 34. 29%), followed by vascular lesions (10/ 35, 28. 57%), with minimal tumor (8/ 35, 22. 86%). The positive rate of endoscopy was 72. 41% (21/ 29) significantly higher than that of the multi-slice spiral CT enterography (52% (13/ 25) (P0.05). There were 8 cases of interstitial tumor of small intestine, 2 cases of lymphoma, 16 cases of inflammatory disease (29. 63%), of which 3 cases of Crohn's disease, 11 cases of nonspecific inflammation, 10 cases of vascular malformation (18.52%), and 9 cases of vascular malformation. For patients with unexplained abdominal pain, the positive rate of X-ray angiography in the digestive tract (18. 18%, 2/ 11) was lowest (P0.05). The positive rates of the multi-slice spiral CT enterography and the capsule endoscopy were 65. 91% (29/ 44) and 65. 71% (23/ 35), respectively (P0.05). Conclusion: The clinical manifestation of small bowel disease is lack of specificity, the cause is inflammatory disease and tumor, when abdominal pain, diarrhea, abdominal bag block, digestive tract bleeding, etc., through gastroscope, intestinal endoscope, stomach and colon diseases, or gastroscope and enteroscopy, it is difficult to explain. The possibility of small bowel disease must be taken into account. The overall detection rate and accuracy rate of small bowel disease, capsule endoscopy and multi-slice spiral CT enterography were significantly higher than that of X-ray angiography in digestive tract. Capsule endoscopy may be preferred for patients with unknown cause of gastrointestinal bleeding. With the rapid development of various inspection techniques, the diagnosis of small bowel disease will be more complete and the rate of discovery will be higher and higher.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R574.5
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