發(fā)布時間：2021-01-07 20:18

　　不明原因的消化道出血（OGIB）是指內(nèi)鏡表現(xiàn)為陰性的持續(xù)性或復發(fā)性出血,約占所有消化道出血的5%。不明原因的消化道出血可分為顯性出血和隱性出血。顯性出血是指初次內(nèi)鏡檢查陰性（食管胃十二指腸鏡和結腸鏡檢查）和影像學檢查陰性（小腸灌腸造影）后復發(fā)或持續(xù)的肉眼可見的出血,如嘔血、便血或黑便。而隱形消化道出血是指大便潛血陽性,伴或不伴有缺鐵性貧血。使用膠囊內(nèi)鏡（CE）和球囊輔助腸鏡（BAE）之前,消化道出血由Treitz韌帶近端或遠端分類。隨著新型小腸鏡技術的引入,消化道出血重新分類為上消化道出血（Vater壺腹近端）、中消化道出血（Vater壺腹至回盲瓣）及下消化道出血（結腸）。標準內(nèi)鏡的高漏檢率和較老診斷模式對小腸評估的局限性影響OGIB的評估,而膠囊內(nèi)鏡、氣囊輔助腸鏡、螺旋腸鏡和CT小腸造影的引入克服了這些局限性。膠囊內(nèi)鏡檢查目前被推薦為雙向內(nèi)鏡檢查陰性后評估OGIB的第三種選擇。氣囊輔助小腸鏡檢查對OGIB的診斷和治療都很有價值。在腔內(nèi)和腔外小腸檢查中,CT小腸造影優(yōu)于小腸X線檢查。小腸診斷和內(nèi)鏡治療的進步已經(jīng)很大程度上取代了外科手術,形成了無創(chuàng)評估及內(nèi)鏡治療OGIB的趨勢。我們報道了... 

【文章來源】：山東大學山東省 211工程院校 985工程院校 教育部直屬院校

【文章頁數(shù)】：63 頁

【學位級別】：碩士

【文章目錄】：
中文摘要
Abstract
INTRODUCTION
    Characterization of OGIB
    Etiology of OGIB
Ⅰ. Vascular
    1. Angioctasias
    2. Dieulafoy lesion
    3. Gastric antral vascular ectasia （GAVE）
    4. Portal hypertensive gastropathy
    5. Varices （esophageal, gastric, small bowel, and colonic）
    6. Hemorrhoids
    7. Radiation enteritis
Ⅱ. Inflammatory
    1. Esophagitis
    2. Peptic ulcer disease
    3. Cameron erosions
    4. Inflammatory bowel disease
    5. Meckel diverticulum
    6. Meckel diverticulum
    7. NSAID-related gastropathy/enteropathy/colopathy
Ⅲ. Neoplastic
    1. Carcinoid tumor
    2. gastrointestinal stromal tumor （GIST）
    3. Adenocarcinoma
    4. Lymphoma
    5. Ampullary adenoma/carcinoma
    6. Metastases （melanoma）
Ⅳ. Extraluminal
    1. Hemobilia
    2. Hemosuccus pancreaticus
    3. Aortoenteric fistula
Ⅴ. Rare causes
    1. Hereditary hemorrhagic telangiectasias
    2. Von Willebrand disease
    3. Pseudoxanthoma elasticum
    4. Amyloidosis
    5. Blue rubber bleb nevus syndrome vasculitis
    6. Henoch Schonlein purpura
Investigation of obscure gastrointestinal bleeding
Diagnostic investigations
    Ⅰ. Endoscopic investigations （repeat upper or lower endoscopy）
    Ⅱ. Push Enteroscopy
    Ⅲ. Capsule Endoscopy
    Ⅳ. Balloon-Assisted deep Enteroscopy
    Ⅴ. Double-balloon enteroscopy
    Ⅵ. single-balloon enteroscopy
    Ⅶ. spiral-enteroscopy
    Ⅷ. intraoperative enteroscopy
    Ⅸ. small bowel contrast radiography
    Ⅹ. cross sectional emaging
    Ⅺ. Scintigraphy
    Ⅻ. angiography
Proposed diagnostic strategy
pharmacologic therapy
    Ⅰ. Anti-angiogenic drugs
        1)Lenalidomide
        2)Thalidomide
        3)Bevacizumab
    Ⅱ. Somatostatin analogues
        1) Long acting release （LAR） octreotide
        2) Octreotide
        3) Lanreotide
    Ⅲ. Hormonal therapy
    Ⅳ. Miscellaneous drugs
        1) Danazol
        2) Antifibrinolytics
            Aminocaproic acid
            Tranexamic acid （TXA）
        3) Recombinant activated factor Ⅶ
        4) Non-selective beta-blockers
        5) Desmopressin
        6) Tamoxifen
References
ACKNOWLEDGEMENT
學位論文評閱及答辯情況表


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