下消化道出血的病因分析及其急性大出血的诊疗策略

发布时间：2018-02-16 13:43

本文关键词： 下消化道出血病因诊疗策略　出处：《山东大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：探讨下消化道出血的病因构成及其在不同年龄段及性别的分布特点,分析每种疾病的疾病特点和诊疗思路,并对不明原因的下消化道出血的不同检查方法进行比较。方法：收集2011年1月1日至2016年3月1日于山东省立医院消化内科住院治疗并确诊为下消化道出血的患者,通过一系列检查手段明确下消化道出血的病因及部位,通过胃镜检查排除上消化道出血,并剔除资料不全、未经系统检查自动出院的患者。选取其中检查资料相对完善共244例患者的临床资料进行回顾性统计分析。根据性别分男女两组,根据年龄分为青年组、中年组、老年组,分别分析各组之间病因分布有无差异。分析总结不同疾病的诊断方法及主要治疗手段,并比较分析不同检查手段对于小肠出血的检出率。结果：1.本次收住的下消化道出血病例中,按照出血分类,依次为肠道感染或炎症(35.6%),结直肠息肉(20.9%),结直肠癌(17.2%),血管病变(9.8%),,痔疮(7.0%),肠道憩室(6.1%),不明原因的小肠出血(4.1%),小肠肿瘤(2.9%)及过敏性紫癜(0.4%),前五位分别是肠道感染或炎症,结直肠息肉,结直肠癌,血管病变,痔疮。2.发生下消化道出血的年龄组中以老年组最多,其次是中年组。对于下消化道出血的发病人数中,青年组与中年、老年组有明显统计学差异(P0.05),而中年组与老年组无明显统计学差异(P0.05)。不同年龄组的疾病种类分布情况不同,老年组结直肠癌所占比例最高(28.8%),青年组及中年组肠道感染或炎症所占比例最高,分别为56.4%,30.0%。3.发生下消化道出血的男性患者(52.02%)多于女性患者(47.98%),但无明显统计学差异(p0,05)。4.在下消化道出血的诊断过程中,不同病因、不同发病部位的疾病需要的检查手段不同,结直肠病变主要通过结肠镜检查及病理学检查诊断,必要情况下可辅以CT检查,小肠出血在行胃镜检查及结肠镜检查排除上消化道出血或结直肠出血的前提下,可根据具体情况行胶囊内镜检查、小肠镜检查、小肠造影、CT检查、DSA、放射性核素检查及术中肠镜或剖腹探查。结论：1.本文中下消化道出血的病因依次为肠道炎症、结直肠息肉、结直肠癌、血管病变、肠道溃疡、痔疮、肠道憩室、不明原因的消化道出血、小肠肿瘤、过敏性紫癜。2.下消化道出血病因分布在不同年龄组有差异。青年组及中年组下消化道出血的最主要病因为肠道感染或炎症,而老年组主要是结直肠癌出血。下消化道出血病因分布性别间无明显差异。3.不同发病部位、不同病种的疾病所需的检查手段不同,结肠镜是各种下消化道出血病因诊断的首要检查手段。
[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.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R574

【相似文献】