80例小肠疾病临床分析
发布时间：2018-11-01 19:47
【摘要】：研究目的:由于小肠其特殊的解剖特点,症状也缺乏特异性,使小肠疾病一直是检查的难点。通过回顾性分析天津医科大学第二医院近6年确诊小肠疾病的80例病例,分析小肠疾病的临床表现、诊断及检查方法,探讨我院小肠疾病的临床特征及我院三种主要检查方法的应用价值,从而增加对小肠疾病的认识,提高对其诊断率。研究方法:纳入自2009年11月至2016年3月就诊于天津医科大学第二医院的80例住院患者,这些患者经临床诊断(包括症状、体征、实验室检查)、影像学诊断(胶囊内镜、消化道X线造影、口服法多层螺旋CT小肠造影)、手术病理已确诊小肠疾病。分析他们的临床表现、诊断及检查方法。比较消化道X线小肠造影、多层螺旋CT小肠造影、胶囊内镜三种主要的检查方法对于小肠疾病总的检出率、确诊率。并根据小肠检查的不同适应症,分析我院三种小肠检查方法的检出率和诊断价值。结果:1.80例小肠疾病的患者中,男性42例,女性38例,男女比为1.11:1,平均年龄52.32岁。临床表现为腹痛的有54例(67.5%),腹部包块42例(52.5%),贫血25例(31.25%),消化道出血35例(43.75%),消瘦33例(41.25%),腹胀11例(13.75%),腹泻8例(10%),食欲不振17例(21.25%),发热7例(8.75%)。2.80例小肠疾病患者中共包括肿瘤40例,占小肠疾病的大多数(50%),分别为小肠腺癌17例,间质瘤16例,淋巴瘤7例,肿瘤中以腺癌(17例,占42.5%)和间质瘤(16例,占40%)为主;另有炎症性疾病16例(20%),包括克罗恩病5例,非特异性炎症11例;还有血管畸形10例,憩室14例。3.80例患者中,消化道X线钡剂造影检查共20例,检出率为25%(5/20),确诊率为10%(2/20)。多层螺旋CT小肠造影检查共57例,检出率为80.70%(46/57),确诊率为52.63%(30/57)。胶囊内镜检查共41例,检出率为70.73%(29/41),确诊率为56.10%(23/41)。多层螺旋CT小肠造影的检出率最高,其次为胶囊内镜,消化道X线钡剂造影的检出率最低,差别均有统计学意义(P0.05)。在确诊率上,消化道X线钡剂造影的确诊率最低,而胶囊内镜和多层螺旋CT小肠造影的确诊率相对较高,且无明显差异(P0.05)。4.35例不明原因消化道出血患者的病因分别为非特异性炎症9例,克罗恩病3例,血管畸形10例,腺癌4例,淋巴瘤1例,间质瘤3例,憩室5例。其中炎症最多(12/35,34.29%),其次为血管性病变(10/35,28.57%),肿瘤最少(8/35,22.86%)。对于不明原因消化道出血患者,胶囊内镜诊断的阳性检出率72.41%(21/29)明显高于多层螺旋CT小肠造影52%(13/25)(P0.05),更明显高于消化道X线造影25%(1/4)(P0.05)。5.54例不明原因腹痛的患者共发现肿瘤21例(38.89%),其中小肠腺癌11例,小肠间质瘤8例,淋巴瘤2例;炎症性疾病16例(29.63%),其中克罗恩病3例,非特异性炎症11例;血管畸形10例(18.52%),此外还有憩室9例。对于不明原因腹痛的病人,消化道X线造影诊断的阳性检出率(18.18%,2/11)最低(P0.05),多层螺旋CT小肠造影与胶囊内镜的阳性检出率分别为65.91%(29/44)和65.71%(23/35),差异无统计学意义(P0.05)。结论:小肠疾病的临床表现缺乏特异性,病因以炎症性疾病及肿瘤多见,当出现腹痛、腹泻、腹部包块、消化道出血等症状,经胃镜、肠镜除外胃和结肠的疾病,或者胃镜、肠镜镜下表现难以解释时,一定要考虑到小肠疾病的可能。对小肠疾病的总体检出率和准确率,胶囊内镜和多层螺旋CT小肠造影均明显高于消化道X线造影检查。对于不明原因消化道出血的病人,胶囊内镜可作为首选检查。随着各种检查技术的飞速发展,小肠疾病的诊断会更加完善,发现率会越来越高。
[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.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R574.5
本文编号：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.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R574.5
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