经病理证实原发性小肠疾病155例临床分析

Clinical analysis of 155 cases of primary small intestinal diseases confirmed by pathology

摘要:

目的：通过回顾性研究，探讨原发性小肠疾病的临床特征及诊断方法。方法：收集2011年1月至2015年12月于重庆医科大学附属第一医院诊治并经病理证实的原发性小肠疾病155例患者的临床资料，对病因、病理诊断、好发部位、临床表现及诊断方法分别探讨。结果：原发性小肠疾病病因以肿瘤为主，占68.39%，又以恶性肿瘤居多。憩室、克罗恩病、肠结核分别占18.29%、5.14%、3.87%。少见病因有急性出血坏死性小肠炎、炎性息肉、糜烂性肠炎。男、女原发性小肠疾病所占比例分别为52.90%、47.02%，平均年龄（56.94±16.48）岁。性别及年龄与病因比较差异无统计学意义，P＜0.05， ?字2值分别为0.027、4.230。原发性小肠疾病主要表现为腹痛伴消化道出血，分别占61.94%、38.06%，也可表现为体质量减轻（26.45%）、恶心呕吐（21.94%）、腹部肿块（17.42%）、发热（12.90%）。临床表现与年龄比较差异无统计学意义（P＜0.05， ?字2=8.020）。胶囊内镜、腹部电子计算机断层成像（CT）、小肠镜检查阳性率分别为72.73%、66.91%、62.50%，腹部CT联合胶囊内镜或小肠镜检查时阳性率分别为90%、83.33%。结论：原发性小肠疾病临床表现不典型，病因以肿瘤多见，对反复腹痛伴消化道出血者应考虑小肠疾病可能，联合使用腹部CT及内镜检查可能会提高原发性小肠疾病的诊断率。

Abstract:

Objective：To investigate the clinical features and the diagnostic methods of primary small intestinal disease. Methods：The clinical data of 155 patients with primary small intestinal diseases diagnosed by pathological examination were collected for this retro－spective study. All patients were admitted to the First Affiliated Hospital of Chongqing Medical University from January 2011 to December 2015. Each patient’s complete clinical data including etiology，pathological diagnosis，predilection site，main clinical symptoms，supplementary examination and final diagnosis were analyzed in the study. Results：The common cause of primary small intestinal disease was the tumor，accounting for 68.39% of all cases，and most of them were malignant tumor. Small intestinal diver－ticulum，Crohn’s disease，and intestinal tuberculosis accounted for 18.29%，5.14%，3.87%，respectively. Other rare causes were acute hemorrhagic necrotizing enteritis，intestinal polyps and erosive enteritis. The proportion of primary small intestinal disease in male and female was 52.90% and 47.02%，respectively. The average age was （56.94±16.48） years. There was no significant difference in gen－der，age and etiology（P<0.05）；the chi-square values were 0.027，4.230 respectively. Abdominal pain was the most common symptom accompanied by gastrointestinal bleeding，weight loss，nausea，vomiting，abdominal mass and fever，accounting for 61.94%，38.06%，26.45%，21.94%，17.42%，12.90%，respectively. There was no significant difference in age and symptom（P<0.05）；the chi-square value was 8.020. The positive diagnostic rates of capsule endoscopy，abdominal CT and small intestinal enteroscopy were 72.73%，66.91% and 62.50% respectively. The positive diagnostic rates of abdominal CT combined with capsule endoscopy or small intestinal enteroscopy were 90% and 83.33% respectively. Conclusion：The clinical manifestations of primary small bowel diseases are lack of specificity，and small bowel tumor was the main cause of primary small intestinal diseases.Small intestinal disease should be highly suspected in patients with abdominal pain and gastrointestinal hemorrhage. Combined abdominal CT and endoscopic examination may improve the diagnosis rate of primary small intestinal diseases.