小肠镜、胶囊内镜和小肠仿真CT在OGIB诊治中的研究

发布时间：2018-05-01 07:05

  本文选题：不明原因消化道出血 + 双气囊小肠镜　； 参考：《大连医科大学》2014年硕士论文

【摘要】：背景及目的 背景：不明原因消化道出血（OGIB, Obscure gastrointestinal bleeding）病因多由小肠疾病引起。小肠是人体最长的器官，所在部位较深，一般检查方法难以到达整个小肠，所以小肠疾病的诊断和治疗成为消化系统疾病的难点，传统的检测方法对小肠疾病的病变诊断率较低。自电子小肠镜（双气囊、单气囊）及胶囊内镜问世以来，，小肠镜可以在内镜下直接观察全小肠粘膜、提供组织学检查和内镜下治疗，胶囊内镜（CE, Capsule endoscopy）检查无创、无痛苦，可完成对整个消化道的检查，小肠仿真CT(CTE, CT enterography)检查可以明确病变的部位、管壁的厚度以及与周围脏器之间的关系，小肠镜与胶囊内镜两种检查方法的出现是21世纪初内镜技术发明的重大创新，它们为小肠疾病的诊断和治疗提供了便利的诊断方法，而小肠仿真CT检查是一种新兴检查技术，尤其对小肠疾病的评估起到重要作用。本研究主要研究以上三种检查方法对OGIB的诊断价值。目的：探讨不明原因消化道出血（OGIB）患者中单气囊小肠镜（Single-balloonenteroscopy）、胶囊内镜、小肠仿真CT对OGIB的阳性检出率及诊断价值。 研究对象及方法： 1、研究对象 1.1研究对象的纳入标准：经常规电子胃镜及电子结肠镜检查后出血原因仍旧不明确（隐性/显性）的持续或反复发作的消化道出血患者。 1.2研究对象的选取 本研究属于回顾性临床研究，根据以上纳入标准选取A组（SBE组）病例为2009年4月至2014年4月北京军区总医院消化内科临床诊断为OGIB患者134例，其中男性83例，女性51例；B组（CE组）病例为2010年9月至2013年10月我院OGIB患者117例；其中男性72例，女性45例。C组（CTE组）病例为2011年11月至2013年9月我院OGIB患者114例，其中男性71例，女性43例。 2、方法 134例OGIB患者接受SBE检查，检查方式根据临床表现选择经口或经肛进镜检查，未发现病灶者，从另一侧进镜再次检查，经口经肛均检查患者27例。117例接受CE检查。SBE联合CE检查患者共16例，114例患者行小肠仿真CT检查。SBE联合CTE检查患者共20例。 结果： 1、SBE组：108例患者发现阳性病灶，其中主要的为息肉性病变占15.7%（21/134），肠粘膜糜烂、溃疡占20.1%（27/134），占位性病变、克罗恩病及憩室各占10.4%（14/134），血管性病变占5.2%(7/134)，间质瘤占4.8%(6/134)，；CE组：100例患者发现阳性病灶，主要包括小肠溃疡、糜烂占38.5%(45/117),息肉占7.7%(9/117)，小肠淋巴管扩张占11.1%(13/117)，小肠血管畸形占8.5%(10/117),小肠黄色瘤占7.7%（9/117）,小肠隆起性病变占6.8%(8/117)，其中有4例发生胶囊滞留，滞留率达3.4%(4/117)；CTE组：55例发现阳性病灶，其中小肠炎性改变占34.2%(39/114),病变符合克罗恩病占7.9%(9/114)。 2、SBE组病灶检出率为80.6%,病因诊断率为78.4%；CE组病灶检出率为85.5%,病因诊断率为59.8%；CTE组病灶检出率为48.2%，病因诊断率为13.2%。16例CE与SBE联合做的患者进行比较，提示SBE与CE的阳性病灶检出率无差异，而在20例SBE与CTE同时做的患者中，SBE的阳性病灶检出率高于CTE。 3、16例患者行SBE检查合并CE检查，其中有4例患者在SBE及CE检查中诊断符合，CE主要遗漏的病变为憩室和克罗恩病。20例患者行SBE检查合并CTE检查，其中有10例患者的诊断结果相同或相似，有4例患者在行CTE检查时怀疑CD，经过SBE检查得到证实。CTE是一项重要的检查工具，可以明确病变的部位、管壁的厚度，及与周围脏器之间的关系，为小肠疾病的诊断提供了有利依据，在OGIB的诊断中CTE对克罗恩病的诊断起到了提示作用。 4、SBE组及CTE组患者检查均较顺利，CE组中2例患者发生回肠末端嵌顿，余患者胶囊均在24~72小时后成功排出体外，胶囊滞留率为3.4%（4/117），3组患者接受检查后均无腹部不适等不良反应及并发症的发生。 结论： 1、本研究中SBE与CE检查方法检出的病因较常见的都为息肉及粘膜糜烂溃疡病变。 2、CE病灶检出率略高于SBE，（P0.05），但两者之间无明显差异。 3、小肠仿真CT在不明原因消化道出血的诊断中对克罗恩病的诊断起到了提示作用，对克罗恩病诊断价值较大。 4、SBE与CE两种检查方法均较可靠，但CE检查更加方便。
[Abstract]:Background and purpose
Background: the etiology of OGIB (Obscure gastrointestinal bleeding) is mostly caused by small intestinal diseases. The small intestine is the longest organ of the human body and its location is deep. The general examination method is difficult to reach the whole small intestine. So the diagnosis and treatment of small intestine diseases become the difficulty of the digestive system disease. The traditional detection method is small. The diagnosis of intestinal diseases is low. Since the advent of electronic enteroscopy (double balloon, single balloon) and capsule endoscopy, small enteroscopy can be used to observe the whole intestinal mucosa directly under endoscopy, providing histological examination and endoscopic treatment. The capsule endoscopy (CE, Capsule endoscopy) examination is noninvasive and painless, and the whole gastrointestinal tract can be examined, small intestine can be completed. The simulation CT (CTE, CT enterography) examination can determine the location of the lesion, the thickness of the wall and the relationship with the surrounding organs. The appearance of two methods of examination of small enteroscopy and capsule endoscopy is a major innovation of the invention of the endoscopy in the early twenty-first Century. They provide a convenient diagnostic method for the diagnosis and treatment of small intestinal diseases, and the small intestine is imitated. True CT examination is an emerging examination technique, especially for the evaluation of small intestinal diseases. This study mainly studies the diagnostic value of the three methods above for the diagnosis of OGIB. Objective: To explore the single balloon enteroscopy (Single-balloonenteroscopy), capsule endoscopy, and CT of the small intestine to OGIB in the patients with unexplained digestive tract hemorrhage (OGIB). The rate of sexual detection and the value of diagnosis.
Research objects and methods:
1, the object of research
1.1 the inclusion criteria of the subjects: recurrent or repeated episodes of gastrointestinal bleeding after regular electronic gastroscopy and electronic colonoscopy, which were still unclear (recessive / dominant).
1.2 selection of research objects
This study belongs to retrospective clinical study. According to the above criteria, the A group (group SBE) was selected as 134 cases of OGIB patients in the digestive department of General Hospital of Beijing Military Region from April 2009 to April 2014, including 83 males and 51 females, and 117 cases of OGIB patients from September 2010 to October 2013 in group B (group CE), of which 72 cases were male, and 117 cases were from September 2010 to October 2013. 45 cases of female.C group (group CTE) were from November 2011 to September 2013, 114 cases of OGIB in our hospital, including 71 males and 43 females.
2, method
134 cases of OGIB patients received SBE examination. The examination methods were selected through oral or anal endoscopic examination according to clinical manifestations. The patients who had not found the lesion were examined again from the other side, 27 cases of.117 cases received CE examination and 16 cases of.SBE combined with CE examination, and 114 patients underwent small bowel simulation CT examination,.SBE combined CTE examination of 20 patients. Example.
Result锛

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