胶囊内镜检查在145例患儿中的临床应用

发布时间：2018-08-07 21:40

【摘要】：目的回顾2012年12月—2016年7月在复旦大学附属儿科医院行胶囊内镜检查的145例患儿的临床资料,评价胶囊内镜检查在儿童中的应用和临床价值。方法回顾性分析145例行胶囊内镜检查患儿的一般资料和临床资料,根据胶囊内镜工作记录,分别统计无法吞服胶囊内镜需胃镜辅助置入、自行吞入但仍需胃镜辅助置入十二指肠和完全不需要胃镜完成胶囊内镜检查的患儿数,胶囊内镜的总工作时间、胃通过时间、小肠通过时间,小肠病变检出情况,观察胶囊内镜检查的安全性,同时分析炎症性肠病(IBD)患儿中胶囊内镜和其他检查的病变检出情况。结果 145例中,男91例、女54例,平均年龄为(10.6±0.3)岁。无法吞服需胃镜辅助下送入胶囊内镜者22例(15.2%),平均年龄为(8.3±0.8)岁;可自主吞服胶囊内镜者123例(84.8%),平均年龄为(11.0±0.3)岁。无法吞服胶囊内镜患儿的年龄显著小于可自主吞服胶囊内镜的患儿(P0.000 1)。在可自主吞服胶囊内镜的123例患儿中,自主吞服胶囊内镜但需胃镜辅助下置入十二指肠者64例(44.1%),平均年龄为(10.6±0.4)岁;完全不需要胃镜完成胶囊内镜检查者59例(40.7%),平均年龄为(11.5±0.3)岁。可自主吞服胶囊内镜的患儿中是否需要胃镜辅助的患儿间年龄的差异无统计学意义(P0.05)。胶囊内镜平均总工作时间为(616.6±7.4)min,平均胃通过时间为(46.7±6.2)min,平均小肠通过时间为(291.9±10.6)min。Pearson相关性分析显示,年龄与胃通过时间、小肠通过时间均无相关性(P值均0.05)。小肠病变检出率为73.1%(106/145),病变类型主要为小肠溃疡。51例IBD患儿中,新发IBD患儿36例,其胶囊内镜检查、结肠镜检查、上下腹部增强CT检查和小肠增强MRI检查的小肠病变阳性发现率分别为100.0%(36/36)、91.7%(33/36)、78.1%(25/32)和86.4%(19/22);IBD复诊患儿15例,其胶囊内镜检查、结肠镜检查、上下腹部增强CT检查和小肠增强MRI检查的小肠病变阳性发现率分别为14/15、11/13、4/5和3/4。完成胶囊内镜检查的患儿均在2周内自主排出胶囊,未发现胶囊内镜滞留现象。结论胶囊内镜检查是一种无创、安全、有效的小肠检查手段,在儿童IBD的诊断和复发监测中有较好的应用价值,在某些小肠疾病的诊断中也发挥着其他检查不能替代的作用,可以在儿科消化领域中推广应用。
[Abstract]:Objective to review the clinical data of 145 children who underwent capsule endoscopy from December 2012 to July 2016 in Pediatrics Hospital affiliated to Fudan University, and to evaluate the application and clinical value of capsule endoscopy in children. Methods the general data and clinical data of 145 children with capsule endoscopy were analyzed retrospectively. According to the working records of capsule endoscopy, it was calculated that the endoscopy could not be swallowed by gastroscope. The number of children who swallowed by themselves but still needed gastroscope to assist the implantation of duodenum and no need to complete capsule endoscopy, the total working time of capsule endoscopy, the time of gastric passage, and the detection of small intestinal lesions. To observe the safety of capsule endoscopy, and to analyze the detection of capsule endoscopy and other pathological changes in children with inflammatory bowel disease (IBD). Results among 145 patients, 91 were males and 54 were females, with an average age of (10.6 卤0.3) years. 22 cases (15.2%) were unable to swallow capsule endoscopy, the average age was (8.3 卤0.8) years old, 123 cases (84.8%) could swallow capsule endoscopy independently, the mean age was (11.0 卤0.3) years. The age of children who could not swallow capsule endoscopy was significantly lower than that of patients who could swallow capsule endoscopy autonomously (P 0.000 1). Among 123 children who could autonomously swallow capsule endoscopy, 64 cases (44.1%) received endoscopy and the average age was (10.6 卤0.4) years old, 59 cases (40.7%) had no need of endoscopy, the average age was (11.5 卤0.3) years old. There was no significant difference in age between children who needed gastroscope in children who could swallow capsule endoscopy autonomously (P0.05). The average total working time of capsule endoscopy was (616.6 卤7.4) min, the mean gastric transit time was (46.7 卤6.2) min, the mean intestinal transit time was (291.9 卤10.6) min.Pearson correlation analysis showed that there was no correlation between age and gastric transit time and intestinal transit time (P < 0. 05). The detection rate of small intestinal lesions was 73.1% (106 / 145). The main types of small bowel lesions were small intestinal ulcers. Among them, 36 cases were newly diagnosed as IBD, including capsule endoscopy and colonoscopy. The positive rates of enhanced CT and enhanced MRI were 100.0% (36 / 36) and 78.1% (25 / 32) and 86.4% (19 / 22), respectively. The positive rates of enhanced CT and enhanced MRI in upper and lower abdomen were 14 / 15 / 11 / 13 / 4 / 5 and 3 / 4 / 4 respectively. All the children who completed the capsule endoscopy excreted the capsule spontaneously within 2 weeks, and there was no phenomenon of capsule endoscopy retention. Conclusion capsule endoscopy is a noninvasive, safe and effective method for small bowel examination. It has a good application value in the diagnosis and recurrence monitoring of IBD in children, and plays an irreplaceable role in the diagnosis of some small bowel diseases. It can be widely used in the field of pediatric digestion.
【作者单位】：复旦大学附属儿科医院消化科;
【分类号】：R725.7

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