系线胶囊内镜在急性上消化道出血中的应用价值

发布时间：2018-03-03 10:32

本文选题：系线胶囊内镜　切入点：胃镜　出处：《福建医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：【目的】探讨系线胶囊内镜对急性上消化道出血诊断的价值、可行性、安全性及患者的耐受程度。【材料与方法】选取于2013年6月至2013年12月就诊我院的拟诊上消化道出血的患者，均以呕血和/或黑便等症状入院；对每名患者进行详细病历资料采集，对其基本资料、现病史、既往史、系线胶囊内镜检查和胃镜检查距最后一次呕血和/或黑便的时间等进行详细记录。对小肠胶进行系线改良，，并对入选病例行系线胶囊内镜检查，待生命征平稳后行胃镜检查，比较其在是否上消化道出血诊断、可能出血病灶的诊断、不良反应、不适评分、及是否愿意重复系线胶囊内镜检查等方面进行比较，并分析是否有统计学意义上的差异。【结果】符合入选标准的病人共40例，其中男性26例，女性14例，年龄在54.8±20.4（20-80岁）岁；行系线胶囊内镜检查的有40例，行胃镜检查的有36例。系线胶囊内镜检查距最后一次呕血和/或黑便的平均时间为31.9±21.0h。系线胶囊内镜下见阳性结果有29例，其中2例为上消化道咖啡样出血，1例为活动性出血，2例为血痂，24例检出可能出血病灶：其中12例为上消化道溃疡，5例为粘膜糜烂出血，2例为胃恶性肿瘤，5例为食管静脉曲张和/或门脉高压性胃病；而检查为阴性的有11例。胃镜检查距最后一次呕血和/或黑便的时间为69.7±22.5h。胃镜下阳性结果有30例，其中1例为活动性出血，1例为血痂，28例检出可能出血病灶：其中19例为上消化道溃疡，3例为粘膜糜烂出血，2例为胃恶性肿瘤，4例为食管静脉曲张出血/或门脉高压性胃病；而检查为阴性的有6例。系线胶囊内镜对上消化道出血阳性结果检出率为72.5%，胃镜的检出率为83.3%，差异有统计学意义；以胃镜为诊断标准，系线胶囊检查的敏感度为93.3%，特异度为83.3%，阳性预测值为96.6%，阴性预测值为83.3%。在40例行系线胶囊内镜检查的患者中有2例（5.0%）分别出现咽部及贲门粘膜充血糜烂出血，均可自行好转；对系线胶囊内镜检查的不适评分的中位数为5.0±2.8分（2-10，以胃镜检查不适为10分为标准）；愿意重复系线胶囊检查者达92.5%。【结论】系线胶囊内镜在急性上消化道出血诊断上，有效性、安全性高，耐受良好；可应用于急性上消化道出血的早期诊断，是急诊胃镜检查的很好补充手段。
[Abstract]:[purpose]. Objective: to evaluate the value, feasibility, safety and tolerance of suture capsule endoscopy in the diagnosis of acute upper gastrointestinal hemorrhage. [materials and methods]. From June 2013 to December 2013, all the patients with upper gastrointestinal bleeding were admitted to hospital with hematemesis and / or black stool, and each patient was collected the detailed medical records, and the basic data, present medical history, past history, and so on, were collected. The time of endoscopy and gastroscopy from the last hematemesis and / or black stool were recorded in detail. To compare the diagnosis of upper gastrointestinal hemorrhage, the diagnosis of possible hemorrhage focus, adverse reactions, discomfort score, and whether they are willing to repeat the capsule endoscopy, and to analyze whether there are statistical differences. [results]. A total of 40 patients met the inclusion criteria, including 26 males and 14 females aged from 54.8 卤20.4 to 80 years old. 36 cases underwent gastroscopy. The average time from the last hematemesis and / or black stool was 31.9 卤21.0 hours. Of them, 2 cases were coffee-like hemorrhage of upper digestive tract, 1 case was active hemorrhage, 2 cases were blood scab, 24 cases were possible bleeding focus: 12 cases were upper digestive tract ulcer, 5 cases were mucosal erosion, hemorrhage 2 cases were gastric malignant tumor, 5 cases were fodder. Varicose vein and / or portal hypertensive gastropathy; However, 11 cases were negative. The time between gastroscopy and the last hematemesis and / or black stool was 69.7 卤22.5h.There were 30 cases with positive results under gastroscopy. Among them, 1 case was active hemorrhage and 1 case was blood scab. Among them, 19 cases were upper digestive tract ulcer, 3 cases were mucosal erosion, 2 cases were gastric malignant tumor, 4 cases were esophageal variceal bleeding or portal hypertensive gastropathy. The positive rate of upper gastrointestinal bleeding was 72.5 and 83.3 respectively, and the difference was statistically significant. The sensitivity, specificity, positive predictive value and negative predictive value were 93.3g, 83.3, 96.6and 83.3respectively. The median of the discomfort score of endoscopy was 5.0 卤2.8 minutes 2-10, and that of gastroscopy was 10, and that of those who were willing to repeat the examination of thread capsule was 92.5%. [conclusion]. The capsule endoscopy is effective, safe and well tolerated in the diagnosis of acute upper gastrointestinal hemorrhage. It can be used in the early diagnosis of acute upper gastrointestinal hemorrhage and is a good supplementary method for emergency gastroscopy.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R573.2

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