- 期刊
使用小腸鏡於診斷不明原因消化道出血之經驗
Experience of Enteroscopy in the Diagnosis of Obscure Gastrointestinal Bleeding
摘要
近年來內視鏡檢查在消化道出血之診斷及治療之重要性己經被確認，然而臨床上仍然有相當數目的病患在經過胃鏡及大腸鏡的檢查後仍然無法找到出血病灶的所在。此類被歸類為不明原因之消化道出血之病患，一部份其出血病灶仍在胃鏡及大腸鏡檢查所涵蓋的區域。之前內視鏡檢查無法找到出血病灶的原因，大致上可以歸納於下列兩大類；一是內視鏡檢查本身之相對性盲點，一是病灶本身不夠明顯，當出血停止時就很難再確認。在經過反覆的檢查之後有部份病患之消化道出血原因仍然不明，很可能出血病灶是位於胃鏡及大腸鏡檢查所無法到達的小腸部份。在此我們對於台大醫院內科之小腸鏡診治經驗做一回顧式的整理。收集過去八年內在台大醫院內科的檢查記錄中，因不明原因消化道出血而進行的檢查及處置，做一敘述性的統計分析，以期了解小腸鏡診治在此類病人處置之成效。在過去八年中我們共進行了186次的小腸鏡檢查，其中有47位病人之61次(32.8%)的檢查是為了不明原因之消化道出血。檢查的結果有27位病人(57.4%)無法找到出血的病灶。進一步的放射性紅血球掃描，血管攝影及小腸攝影與剖腹探查，找到5位病人的出血病灶所在位置。而有20位病人(42.6%)可以確定找到出血的病灶。其中有6位病人的出血病灶是位於胃部。有6位病人的出血病灶是位於十二指腸部，包括有十二指腸潰瘍（3位）、血管生成異常（2位）及十二指腸憩室併潰瘍（1位）。有8位病人的出血病灶確定是位於空腸之近端部，包括有黏膜下腫瘤（4位都是GIST）、血管生成異常（2位）、空腸潰瘍及空腸出血原因不明（各1位）。對於不明原因之消化道出血病例，在進一步的小腸鏡檢查後，有四成的病人可以找到出血的病灶。
並列摘要
In the past eight years at NTUH, enteroscopy examinations were performed 186 times. Among these, 32.8% (61/186) of them were taken for gastrointestinal bleeding of obscure origin in 47 patients (22 female and 25 male). One of the patients received 8 times, two received 3 times and three of them received 2 times. There was neither active bleeder nor suspicious lesions in 57.4% (27/47) patients. Further studies showed positive findings in 5 patients including Tc-99m labeled RBC scan in three patients, angiography in one (ascending colon angiodysplasia) and operation proof in one (Meckel's diverticulum with ulcer 70cm above ileocecal valve). On the contrary, active bleeders or suspicious sources of bleeding were found in 42.6% (20/47) patients. The locations of the bleeding focus were 30% (6/20) in stomach, 30% (6/20) in duodenum and 40% (8/20) in jejunum. The 6 gastric lesions included two gastric ulcers, two congestive gastropathy, one hemorrhagic gastritis and one Dieulafoy's ulcer. The 6 duodenal lesions included three duodenal ulcers, two angiodysplasia and one diverticulum with ulcer At last, the 8 lesions in jejunum were two angiodysplasia, one jejunal bleeding without definite etiology, one jejunal ulcer two submucosal tumors with ulcer (gastrointestinal stromal tumor proved by surgical specimens), one suspicious cavernous hemangioma (GIST after operation) and a jejunal tumor (proved as GIST, also). In summary, the enteroscopy could find out around 40% causes of bleeding for the obscure gastrointestinal bleeding according to our experiences.