不明原因胃肠道出血

发布时间：2021-01-07 20:18

　　不明原因的消化道出血（OGIB）是指内镜表现为阴性的持续性或复发性出血,约占所有消化道出血的5%。不明原因的消化道出血可分为显性出血和隐性出血。显性出血是指初次内镜检查阴性（食管胃十二指肠镜和结肠镜检查）和影像学检查阴性（小肠灌肠造影）后复发或持续的肉眼可见的出血,如呕血、便血或黑便。而隐形消化道出血是指大便潜血阳性,伴或不伴有缺铁性贫血。使用胶囊内镜（CE）和球囊辅助肠镜（BAE）之前,消化道出血由Treitz韧带近端或远端分类。随着新型小肠镜技术的引入,消化道出血重新分类为上消化道出血（Vater壶腹近端）、中消化道出血（Vater壶腹至回盲瓣）及下消化道出血（结肠）。标准内镜的高漏检率和较老诊断模式对小肠评估的局限性影响OGIB的评估,而胶囊内镜、气囊辅助肠镜、螺旋肠镜和CT小肠造影的引入克服了这些局限性。胶囊内镜检查目前被推荐为双向内镜检查阴性后评估OGIB的第三种选择。气囊辅助小肠镜检查对OGIB的诊断和治疗都很有价值。在腔内和腔外小肠检查中,CT小肠造影优于小肠X线检查。小肠诊断和内镜治疗的进步已经很大程度上取代了外科手术,形成了无创评估及内镜治疗OGIB的趋势。我们报道了... 

【文章来源】：山东大学山东省 211工程院校 985工程院校 教育部直属院校

【文章页数】：63 页

【学位级别】：硕士

【文章目录】：
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
学位论文评阅及答辩情况表


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