| Objective: By analyzing the distribution of explore OGIB related causes and diagnostic methods and meanwhile, providing the vital basis for the clinical diagnosis and treatment.Methods: To collect from January 2009 to December 2009, because of "OGIB" and admitted to our hospital 156 cases of patients, retrospective analysis the clinical data, to summarize the clinical curative effect of the medical treatment. Inclusion criteria:(1)Check initial stomach are negative, found no obvious hemorrhage stove;(2)Acute blood loss, in critical condition, bleeding for unknown reasons, medical treatment is invalid or poor curative effect of gastrointestinal bleeding, need to turn to surgery.(3)After further examination or surgery pathological diagnosis. Exclusion criteria:(1)Initial examination revealed bleeding regular stomach bleeding lesions can be clearly the reason.(2)Finally not clear diagnosis.Results: Unknown causes gastrointestinal bleeding in patients 156 cases, 94 cases of male, female 62 cases, ratio of 1.52:1, aged 21 to 88 years old, the average(49.9 and 16.39). The first of the 156 patients with OGIB, small intestinal tumor, accounting for 16.67% of the total disease, followed by intestinal polyp nonspecific inflammation, accounted for 12.18%, small intestinal vascular malformation in company with hemobilia in third, 9.62%, colon tumor accounted for 8.33%, 5.13% and 5.77% respectively, and the small intestine and colon polyp crohn’s disease(5.13%), diverticulum(3.83%), gastric and duodenal ulcer accounted for 3.20% and 4.48%, respectively.Different age of people, < 30 patients before check out the three pathological changes is a duodenal ulcer, intestinal polyp, intestinal tuberculosis; 30-40 patients with bleeding causes more in, nonspecific inflammation in the intestine, small intestine tumor; 40-60 patients with hemorrhage reason may be small intestinal tumor, nonspecific inflammation; > 60 patients with lesions found in the intestinal tumors and vascular malformation. Different inspection methods for OGIB diagnostic role, capsule endoscopy and enteroscopy positive rate is higher, at 77.55% and 75% respectively, MDCT also has a high diagnostic rate, at 70%, repeated stomach, colonoscopy examination can improve diagnosis rate.Conclusion: For unknown reason the digestive tract hemorrhage patients, in a critical condition, diagnosis, treatment of direction is not clear, the clinician must be highly vigilant intestinal diseases, attaches great importance to the stromal tumor, hemangioma, water breakthrough bleeding diseases. Should choose angiography and radionuclide scanning, MDCT, capsule endoscopy and enteroscopy and so on carries on the comprehensive analysis, and at the same time to be reckoned with colour to exceed. When medical treatment is invalid, should be timely surgical treatment, treatment time, reducing patient pain and risk.According to the American gastroenterological association(AGA) in view of the process of diagnosis and treatment of OGIB formulation, coupled with China’s national conditions, the modified OGIB recommended treatment process is as follows: the first diagnosis in patients with OGIB, if any overt bleeding, medical intervention is invalid, first select angiography, positive line embolism and hemostatic treatment at the same time; Recessive bleeding or if the bleeding is not big, repeat routine endoscopic examination, found that the cause is related to treatment; If negatie endoscopy again, along with angiographic negatie, line of small intestine, capsule endoscopy and enteroscopy examination, CT was the etiological treatment, negatie bleeding has control, strengthen follow-up; If the check has not been found the cause, bleeding after medical treatment still not controller, surgical treatment and combined intraoperative endoscopy when necessary. |
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