双气囊小肠镜对小肠疾病诊断价值
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摘要
目的探讨双气囊小肠镜在小肠疾病诊断中的价值及安全性。方法回顾性分析自2014年1月至2015年12月于沈阳军区总医院消化内科行双气囊小肠镜检查的183例患者临床资料。根据患者病情选择经口或经肛的进镜方法,其中,经口67例,经肛97例,双向进镜19例。若发现病变,行病理学检查。结果经口进镜67例,经肛进镜97例,双向进镜19例。阳性病变检出率为85. 2%(156/183)。其中,小肠溃疡占17. 4%(32/183);小肠息肉占13. 1%(24/183);克罗恩病占9. 2%(17/183),小肠良、恶性肿瘤占8. 7%(16/183),小肠非特异性炎性改变占6. 0%(11/183)。经双气囊小肠镜检查后,65. 3%(64/98)患者可明确消化道出血的病因。所有患者检查过程中及结束后均未发生严重并发症,仅有少数患者有咽部不适、轻微腹胀等,均可自行缓解。结论双气囊小肠镜对小肠疾病阳性检出率较高,检查安全有效,是诊断小肠疾病的重要手段。
Objective To investigate the diagnostic value and safety of double balloon enteroscopy in small intestine diseases. Methods A retrospective study was performed on 183 cases of patients with small intestine diseases who underwent double balloon enteroscopy from January 2014 to December 2015. According to the patient's condition,the method of transoral or transanal endoscopy was selected,among which,there were 67 cases of transoral,97 cases of transanal and 19 cases of bilateral endoscopy. If lesions were found,pathological examination would be performed. Results There were 67 cases of transoral endoscopy,97 cases of transanal endoscopy and 19 cases of bilateral endoscopy. The detection rate of positive lesions was 85. 2%( 156/183). Small intestinal ulcer accounted for17. 4%( 32/183),intestinal polyps accounted for 13. 1%( 24/183),Crohn' s disease was 9. 2%( 17/183),benign and malignant small intestinal tumors was 8. 7%( 16/183),and non-specific inflammatory changes in small intestine was 6. 0%( 11/183). After double balloon colonoscopy,65. 3%( 64/98) of the patients could be identified as the cause of gastrointestinal bleeding. No serious complications occurred during and after the examination,and only a few patients had pharyngeal discomfort and slight abdominal distension,which could be relieved by themselves. Conclusion Double balloon enteroscopy is a safe diagnostic method for small intestine diseases with a high detection rate and safety.
Objective To investigate the diagnostic value and safety of double balloon enteroscopy in small intestine diseases. Methods A retrospective study was performed on 183 cases of patients with small intestine diseases who underwent double balloon enteroscopy from January 2014 to December 2015. According to the patient's condition,the method of transoral or transanal endoscopy was selected,among which,there were 67 cases of transoral,97 cases of transanal and 19 cases of bilateral endoscopy. If lesions were found,pathological examination would be performed. Results There were 67 cases of transoral endoscopy,97 cases of transanal endoscopy and 19 cases of bilateral endoscopy. The detection rate of positive lesions was 85. 2%( 156/183). Small intestinal ulcer accounted for17. 4%( 32/183),intestinal polyps accounted for 13. 1%( 24/183),Crohn' s disease was 9. 2%( 17/183),benign and malignant small intestinal tumors was 8. 7%( 16/183),and non-specific inflammatory changes in small intestine was 6. 0%( 11/183). After double balloon colonoscopy,65. 3%( 64/98) of the patients could be identified as the cause of gastrointestinal bleeding. No serious complications occurred during and after the examination,and only a few patients had pharyngeal discomfort and slight abdominal distension,which could be relieved by themselves. Conclusion Double balloon enteroscopy is a safe diagnostic method for small intestine diseases with a high detection rate and safety.
引文
[1]刘梅.小肠疾病的内镜诊断方法[J].临床内科杂志,2010,27(2):80-82.
[2]郑贤应,李银官,邹莹,等. MRI在小肠疾病诊断中的应用价值[J].中华放射学杂志,2009,43(10):1056-1061.
[3]周锋利,郑萍,翁坚军.单气囊小肠镜在44例小肠疾病诊断中的价值[J].实用临床医药杂志,2011,15(5):66-67.
[4]张德中.小肠出血的病因和诊治原则[J].胃肠病学,2002,7(2):96-98.
[5]智发朝,白杨,徐智民,等.双气囊内镜与胶囊内镜检查对小肠疾病诊断价值的对比研究[J].中国消化内镜,2007,1(5):24-27.
[6]Yamamoto H,Sugano K. A new method of enteroscopy--the double-balloon method[J]. Can J Gastroenterol,2003,17(4):273-274.
[7]刘吉勇,姜军梅,林立明,等.双气囊电子镜在小肠疾病诊断与治疗中的作用[J].中华消化内镜杂志,2007,24(2):112-114.
[8]智发朝,白杨,徐智民,等.双气囊内镜检查对小肠溃疡病变的诊断研究[J].中华消化内镜杂志,2008,25(9):449-452.
[9]卞德建,杜奕奇,李兆申.小肠镜在小肠疾病治疗领域中的应用[J].中华消化内镜杂志,2013,30(12):718-720.
[10]May A,Nachbar L,Pohl J,et al. Endoscopic interventions in the small bowel using double balloon enteroscopy:feasibility and limitations[J]. Am J Gastroenterol,2007,102(3):527-535.
[11]Despott EJ,Gupta A,Burling D,et al. Effective dilation of smallbowel strictures by double-balloon enteroscopy in patients with symptomatic Crohn's disease(with video)[J]. Gastrointest Endosc,2009,70(5):1030-1036.
[12]Ross AS,Semrad C,Waxman I,et al. Enteral stent placement by double balloon enteroscopy for palliation of malignant small bowel obstruction[J]. Gastrointest Endosc,2006,64(5):835-837.
[13]Mehdizadeh S,Lo SK. Treatment of small-bowel diaphragm disease by using double-balloon enteroscopy[J]. Gastrointest Endosc,2006,64(6):1014-1017.
[14]李晓波,陈慧敏,戴军,等.胶囊内镜指导双气囊内镜进镜方式的临床研究[J].中华消化内镜杂志,2010,27(8):396-398.
[15]龚伟,肖冰,白杨,等.气囊辅助小肠镜对不明原因消化道出血的诊断与治疗[J].中华消化内镜杂志,2011,21(10):534-537.
[16]Xin L,Liao Z,Jiang YP,et al. Indications,detectability,positive findings,total enteroscopy,and complications of diagnostic double-balloon endoscopy:a systematic review of data over the first decade of use[J]. Gastrointest Endosc,2011,74(3):563-570.
[17]Di Caro S,May A,Heine DG,et al. The European experience with double-balloon enteroscopy:indications,methodology,safety,and clinical impact[J]. Gastrointest Endosc,2005,62(4):545-550.
[2]郑贤应,李银官,邹莹,等. MRI在小肠疾病诊断中的应用价值[J].中华放射学杂志,2009,43(10):1056-1061.
[3]周锋利,郑萍,翁坚军.单气囊小肠镜在44例小肠疾病诊断中的价值[J].实用临床医药杂志,2011,15(5):66-67.
[4]张德中.小肠出血的病因和诊治原则[J].胃肠病学,2002,7(2):96-98.
[5]智发朝,白杨,徐智民,等.双气囊内镜与胶囊内镜检查对小肠疾病诊断价值的对比研究[J].中国消化内镜,2007,1(5):24-27.
[6]Yamamoto H,Sugano K. A new method of enteroscopy--the double-balloon method[J]. Can J Gastroenterol,2003,17(4):273-274.
[7]刘吉勇,姜军梅,林立明,等.双气囊电子镜在小肠疾病诊断与治疗中的作用[J].中华消化内镜杂志,2007,24(2):112-114.
[8]智发朝,白杨,徐智民,等.双气囊内镜检查对小肠溃疡病变的诊断研究[J].中华消化内镜杂志,2008,25(9):449-452.
[9]卞德建,杜奕奇,李兆申.小肠镜在小肠疾病治疗领域中的应用[J].中华消化内镜杂志,2013,30(12):718-720.
[10]May A,Nachbar L,Pohl J,et al. Endoscopic interventions in the small bowel using double balloon enteroscopy:feasibility and limitations[J]. Am J Gastroenterol,2007,102(3):527-535.
[11]Despott EJ,Gupta A,Burling D,et al. Effective dilation of smallbowel strictures by double-balloon enteroscopy in patients with symptomatic Crohn's disease(with video)[J]. Gastrointest Endosc,2009,70(5):1030-1036.
[12]Ross AS,Semrad C,Waxman I,et al. Enteral stent placement by double balloon enteroscopy for palliation of malignant small bowel obstruction[J]. Gastrointest Endosc,2006,64(5):835-837.
[13]Mehdizadeh S,Lo SK. Treatment of small-bowel diaphragm disease by using double-balloon enteroscopy[J]. Gastrointest Endosc,2006,64(6):1014-1017.
[14]李晓波,陈慧敏,戴军,等.胶囊内镜指导双气囊内镜进镜方式的临床研究[J].中华消化内镜杂志,2010,27(8):396-398.
[15]龚伟,肖冰,白杨,等.气囊辅助小肠镜对不明原因消化道出血的诊断与治疗[J].中华消化内镜杂志,2011,21(10):534-537.
[16]Xin L,Liao Z,Jiang YP,et al. Indications,detectability,positive findings,total enteroscopy,and complications of diagnostic double-balloon endoscopy:a systematic review of data over the first decade of use[J]. Gastrointest Endosc,2011,74(3):563-570.
[17]Di Caro S,May A,Heine DG,et al. The European experience with double-balloon enteroscopy:indications,methodology,safety,and clinical impact[J]. Gastrointest Endosc,2005,62(4):545-550.