280例胶囊内镜在小肠疾病诊断中的应用及随访

发布时间：2018-04-16 21:35

本文选题：胶囊内镜 + 小肠疾病　；参考：《河北医科大学》2014年硕士论文

【摘要】：目的：小肠冗长（全长约5~7米），肠管呈盘曲折叠式排列、解剖位置较深，使传统检查手段的应用受到较大程度的限制，因此临床上一直较难准确诊断小肠疾病，而胶囊内镜这一全新、无创、全消化道检查手段的问世，为小肠疾病的直视下诊断提供了重要方法，使小肠疾病的诊断产生了质的飞跃。国内外已有大量文献证实胶囊内镜对小肠疾病有较高的诊断价值，但是关于行胶囊内镜检查后较大样本量的随访研究较少，本文对280例行胶囊内镜检查者的临床资料进行分析，并结合随访情况，确定胶囊内镜与最终临床诊断符合情况，进一步探讨胶囊内镜在小肠疾病中的应用价值。方法：对2007年04月至2013年11月间于河北医科大学第二医院行国产OMOM胶囊内镜检查的280例受检者进行回顾性分析和随访，随访时间从5个月至7年不等，其中男性171例，女性109例，年龄17～80岁之间，最后对相关结果应用统计学方法进行分析。结果： 1胶囊内镜运行时间：胶囊内镜在食道内平均运行时间28.7±10.8(4～54)s，胃内运行时间48.5±40.8(2～189)min，到达幽门的时间49.3±41.5(2.2～189.1)min；到达回盲瓣的时间为258.7±60.8(59～499)min，小肠内运行时间304.8±61.2(64.7～501.4)min。 2胶囊内镜检查成功率99.3%（278/280），病变检出率66.4%（186/280），漏诊率0.7%（2/280）,过瓣率为87.5%（245/280）。 3胶囊内镜小肠病变检出结果：胶囊内镜病变总检出率66.4%（186/280），主要检出病变为血管病变占20.4%（57/280）、非特异性炎症占11.8%（33/280）、溃疡性病变占9.6%（27/280）、占位性病变22例占7.9%（22/280)，其它检出病变依次为息肉5.0%（14/280）、淋巴管扩张4.3%（12/280）、克罗恩病2.5%（7/280）、活动性出血1.8%（5/280)、憩室1.1%（3/280）、黄斑瘤1.1%（3/280）、间质瘤0.7%（2/280)、脂肪瘤0.4%（1/280）。 4不同症状三组胶囊内镜检查结果：①不明原因消化道出血组病变检出率70.0%（140/200），以血管病变25.5%（51/200）、非特异性炎症10.5%（21/200）、占位性病变9.5%（19/200）、溃疡性病变9.0%（18/200）为主；②不明原因腹痛组病变检出率为58.6%（34/58）。以小肠非特异性炎症13.8%（8/58）、小肠溃疡性病变12.1%（7/58）较为常见；③其他症状组病变检出率54.5%（12/22）。三症状组病变检出率进行卡方检验无显著差异。 5胶囊内镜并发症：3例受检者（1.1%）发生胶囊滞留，均通过手术取出滞留胶囊内镜。 6随访：胶囊内镜检查后随访率为60.4%（169/280），青少年组、中年组、老年组随访率分别为54.9%（39/71）、57.9%(81/140）、71.0%(49/69)，各年龄组间行卡方检验无显著差异。行胶囊内镜检查后共51例患者接受进一步诊治并确诊，27例首先行小肠镜检查，6例首先行血管造影检查，11例直接行手术剖腹探查和治疗者，5例可疑NASIDS相关性溃疡、2例可疑过敏性紫癜者行诊断性治疗试验。最终共确诊51例，分别为溃疡性病变7例、非特异性炎症6例、血管扩张6例、NASIDS相关性溃疡5例、憩室5例、血管畸形3例、血管瘤3例、间质瘤3例、息肉2例、2例过敏性紫癜、黄斑瘤1例、脂肪瘤1例、隐源性多灶性溃疡性狭窄性小肠炎1例、神经内分泌肿瘤1例，另外5例患者未见异常。 7胶囊内镜诊断与最后诊断的符合情况：胶囊内镜在小肠疾病诊断中的诊断符合率为76.5%(39/51）、其中不明原因消化道出血患者组诊断符合率为88.9%（32/36）。结论： 1胶囊内镜对小肠疾病有较高的诊断价值，，特别是对不明原因消化道出血患者的诊断。 2应重视胶囊内镜检查后的随访工作。
[Abstract]:Objective: the small intestine long (total length of about 5~7 meters), a coiled intestinal folding arrangement, anatomy is deep, the application of traditional examination method is more limited, so the clinical practice has been more difficult to accurately diagnose small bowel disease, and capsule endoscopy in this new, non-invasive examination means, the advent of the whole digestive tract. An important method to provide diagnosis of small bowel diseases under direct vision, make the diagnosis of small bowel diseases had a qualitative leap. A lot of literature at home and abroad have been confirmed to have higher diagnostic value of capsule endoscopy in small bowel diseases, but not a follow-up study of larger sample size for capsule endoscopy examination, the clinical data of 280 cases of capsule endoscopy the analysis, combined with the follow-up situation, determine the capsule endoscopy with the final clinical diagnosis, to further explore the application value of capsule endoscopy in small intestinal diseases.
Methods: in 2007 04 months to November 2013 in the second hospital of Hebei Medical University underwent OMOM capsule endoscopy examination of 280 cases of subjects were retrospectively analyzed and followed up. The follow-up time ranged from 5 months to 7 years, there were 171 males and 109 females, between the age of 17~80 years, the application of the statistical method carries on the analysis.
Result:
Running time: 1 capsule endoscopy capsule endoscopy in the esophagus the average running time of 28.7 (4~54 + 10.8) s, intragastric running time 48.5 + 40.8 (2~189) min, arrival time of 49.3 + 41.5 HP (2.2 ~ 189.1) min; at the ileocecal valve time was 258.7 + 60.8 (min 59~499), small intestine in the running time of 304.8 + 61.2 (64.7 ~ 501.4) min.
The success rate of 2 capsule endoscopy was 99.3% (278/280), the detection rate of lesions was 66.4% (186/280), the rate of missed diagnosis was 0.7% (2/280), and the rate of over valve was 87.5% (245/280).
Capsule endoscopy small bowel lesions were detected in 3 Results: the total detection rate of 66.4% lesions of capsule endoscopy (186/280), the main lesions of vascular lesions accounted for 20.4% (57/280), nonspecific inflammation accounted for 11.8% (33/280), ulcerative lesions accounted for 9.6% (27/280), lesions in 22 cases accounted for 7.9% (22/280), other lesions in 5% polyps (14/280), lymphatic dilatation in 4.3% (12/280), 2.5% Crohn's disease (7/280), active bleeding in 1.8% (5/280), 1.1% (3/280), macular diverticulum in 1.1% (3/280), 0.7% stromal tumors (2/280), 0.4% lipoma (1/280).
4 different symptoms of the three groups of capsule endoscopy results: obscure gastrointestinal bleeding group lesion detection rate of 70% (140/200), 25.5% (51/200) in vascular disease, nonspecific inflammation, 10.5% (21/200) lesions were 9.5% (19/200), ulcerative lesions in 9% (18/200); group II unexplained abdominal pain the detection rate of lesions was 58.6% (34/58) in small intestine. Nonspecific inflammation in 13.8% (8/58), small intestinal ulcer lesions 12.1% (7/58) are common; other symptoms group lesion detection rate of 54.5% (12/22). The three group of symptoms of disease detection rate by chi square test showed no significant difference.
5 capsule endoscopy complications: 3 cases (1.1%) had capsule retention, and all the capsule endoscopy was taken out by operation.
6 follow up: after capsule endoscopy, the follow-up rate was 60.4% (169/280). The follow-up rates in the adolescent group, the middle-aged group and the elderly group were 54.9% (39/71), 57.9% (81/140), and 71% (49/69), respectively. There was no significant difference in Chi square test among all age groups.
For capsule endoscopy after a total of 51 patients underwent further treatment and diagnosis, 27 cases of first endoscopy, 6 cases of first line angiography, 11 cases underwent surgical exploration and treatment of direct laparotomy, 5 cases of suspected NASIDS related ulcer, 2 cases of suspected allergic purpura underwent diagnostic treatment. The final test confirmed 51 cases were ulcerative lesions in 7 cases, 6 cases of nonspecific inflammation, vascular dilatation in 6 cases, 5 cases of NASIDS related peptic ulcer, diverticulum in 5 cases, 3 cases of vascular malformation, 3 cases of hemangioma, 3 cases of stromal tumors, 2 cases of polyp, 2 cases of allergic purpura, 1 cases of macular tumor, 1 cases of lipoma, 1 cases of cryptogenic multifocal ulcerative enteritis stenosis, 1 cases of neuroendocrine tumors, and 5 patients were abnormal.
7 the coincidence of capsule endoscopy diagnosis and final diagnosis: the coincidence rate of capsule endoscopy in the diagnosis of small intestinal diseases was 76.5% (39/51), and the diagnostic coincidence rate of patients with obscure gastrointestinal bleeding was 88.9% (32/36).
Conclusion:
1 capsule endoscopy is of high diagnostic value for small intestinal diseases, especially for patients with unexplained gastrointestinal bleeding.
2 should pay attention to the follow-up work after the capsule endoscopy.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R574.5

【引证文献】