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论著:胶囊内镜检查对小肠疾病的诊断价值
Value of Capsule Endoscopy in the Diagnosis of Intestinal Diseases
曹海滨 黄继英 高虹 时宝忆
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作者单位:复旦大学附属中山医院青浦分院消化科
中文关键字:胶囊内镜;小肠疾病;高龄患者
英文关键字:Capsule endoscopy; Ntestinal diseases; Senile patient
中文摘要:目的:分析胶囊内镜在消化道疾病中的应用,探讨可能影响其检查结果的因素。
方法:疑有消化道疾病但经胃镜、肠镜和腹部超声后均不能明确诊断的患者37例,按年龄分为2组,其中≥70岁为高龄组(20例)。对37例患者进行胶囊内镜检查,并对可能影响胶囊内镜检查的因素如年龄、性别、腹部手术史、糖尿病史、是否服用非甾体类消炎药等做多因素回归分析。结果:37例患者经胶囊内镜检查后,明确诊断16例(43.2%);可疑诊断13例(35.1%);阴性病例8例(21.6%)。总检出率为78.4%。胶囊内镜检出小肠克隆氏病1例,小肠腺癌1例,出血性空肠炎1例,升结肠癌1例,血管显露、血管发育不良26例,小肠炎症10例,小肠息肉11例。本研究中,高龄患者的食管内时间、胃内时间和小肠内时间较长,但2组差异无统计学意义;37例均无胶囊滞留体内,但有1例食管滞留和1例胃内滞留,且均发生在高龄组;1例褐色肠液多影响观察,1例图像存在干扰影响观察。本研究有5例胶囊未进入结肠,视为未完成小肠检查,均发生在高龄患者中,2组差异具有统计学意义(t=-2.315,P=0.027),说明年龄对于小肠的检查有影响。多因素回归分析显示,腹部手术史、糖尿病史、服用非甾体类消炎药药物史等2组差异均无统计学意义。结论:对于怀疑小肠疾患而无检查禁忌的高龄患者,胶囊内镜可作为首选检查,因其具有安全、无痛苦、顺应性好等优点而易于被患者接受。但高龄患者的胃肠道活动减弱,食管和胃内滞留率增高,小肠通过时间延长,所以在胶囊内镜的检查过程中应加强监测,可予增加胃肠蠕动的药物。
英文摘要:Objective:To investigate the value of capsule endoscopy in intestinal diseases.
Methods:A total of 37 patients suspected of digestive diseases, without clear diagnosis by gastroscopy, colonoscopy and abdominal ultrasound, were inspected by capsule endoscopy. Among the 37 cases, 20 were above 70 years of age. Factors like age, gender, abdominal surgery history, diabetes history and non steroidal expectorant history were analyzed by multivariate regression models. Results: After the inspection of capsule endoscopy, 16 cases were confirmedly diagnosed, 13 cases were suspiciously diagnosed and 8 cases were still not diagnosed. The diagnostic rate was 78.4%. The patients diagnosed by capsule endoscopy consisted of 1 intestinal Crohn disease, 1 small intestinal tumor, 1 small intestinal erosion with blooding, 1 colon tumor, 26 small intestinal angiodysplasia, 10 intestinal inflammation and 11 mutipolypi in the intestine. There was a slight delay in esophagus time, stomach time, small intestine time in patients above 70 year old, but the difference was not statistically significant. Among the patients above 70 years old, 5 cases did not complete the inspection of the small intestine, which indicated that age could affect the inspection (P=0.027). While abdominal surgery history, diabetes history, non steroidal expectorant history had no influence on the inspection of capsule endoscopy. There was a case of esophageal retention, a case of stomach stranded among the patients above 70 years old. There were no capsule stranded in the bodies of all 37 cases. One case was influenced by too much brown intestinal fluid and one case was disturbed in the observation. Conclusions: For senile patients with small intestinal diseases without inspection contraindications, capsule endoscopy inspection is the first choice.Monitoring is important for them because of slow gastrointestinal activity. Gastroscopy or drugs may be needed to increase the activity.
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