OMOM胶囊内镜对小肠疾病诊断价值的研究

发布时间：2018-06-28 20:02

本文选题：胶囊内镜 + 小肠疾病　；参考：《中南大学》2014年硕士论文

【摘要】：目的：探讨国产OMOM胶囊内镜对小肠疾病的诊断价值及安全性。方法：回顾性分析我院2011年1月至2014年1月因消化系统症状就诊行胃镜、结肠镜等常规检查没有可解释临床症状的阳性发现的疑诊小肠疾病208例患者的临床资料、OMOM胶囊内镜检查结果,并进行电话随访以了解其诊断的准确性及疾病转归。并与同期所做的全消化道钡餐或腹部CT或双气囊小肠镜对小肠疾病的病因诊断率进行比较。结果： 1.208例患者,203例检查成功,检查成功率97.59%(203/208)。老年人以OGIB为检查原因的比例明显高于儿童、中青年(64.06%vs34.72%),而儿童、中青年则以腹痛为检查原因的比例明显高于老年人(56.25%vs31.25%)。 2.胶囊内镜对小肠病变的总病变检出率为66.01%(134/203),前四位阳性发现分别是小肠溃疡、黏膜炎症、血管畸形、占位性病变。总病因诊断率为35.96%(73/203),前四位病因诊断分别是为小肠克罗恩病、血管畸形、小肠肿瘤、寄生虫病。 3.胶囊内镜对各组小肠疾病的检出结果： ①胶囊内镜对不明原因消化道出血组的检出结果：病变检出率为80.68%(71/88),阳性发现主要有血管畸形、占位性病变、小肠溃疡、黏膜炎症；病因诊断率为52.27%(46/88),病因诊断主要有血管畸形、小肠肿瘤、小肠克罗恩病。②胶囊内镜对腹痛组的检出结果：病变检出率为55.00%(55/100),阳性发现主要有小肠溃疡、黏膜炎症、血管病变、小肠憩室；病因诊断率为23.00%(23/100),病因诊断主要有小肠克罗恩病、寄生虫病、小肠憩室等；③胶囊内镜对腹泻组的检出结果：病变检出率为61.54%(8/13),阳性发现主要有黏膜炎症、小肠溃疡等；病因诊断率为30.77%(4/13),病因诊断有小肠克罗恩病,嗜酸细胞性肠炎。 4.胶囊内镜与全消化道钡餐、腹部CT、双气囊小肠镜对小肠疾病诊断率比较：全消化道钡餐病因诊断率8.04%(9/112),胶囊内镜36.61%(41/112),两者比较差异有统计学意义(P0.05),两者联合诊断的病因诊断率为38.39%(43/112),与单纯胶囊内镜比较差异有统计学意义(P0.05)；腹部CT的病因诊断率16.67%(14/84),胶囊内镜29.76%(25/84),两者比较差异有统计学意义(P0.05),两者联合诊断的病因诊断率为32.14%(27/84),与单纯胶囊内镜比较差异有统计学意义(P0.05)；；双气囊小肠镜的病因诊断率53.85%(7/13),胶囊内镜53.85(7/13),两者比较差异无统计学意义(P0.05),两者联合诊断的病因诊断率为69.23%(9/13),与单纯胶囊内镜比较差异无统计学意义(P0.05)。 5.胶囊内镜的镜下诊断与病理诊断符合率为66.67%(14/21),对小肠间质瘤的符合率为70%(7/10)。 6.全小肠检查率66.70%(136/203),胃运行时间超过45min、小肠克罗恩病是胶囊内镜未完成全小肠检查的危险因素。 7.胶囊内镜的耐受性及并发症：3例患者发生胶囊滞留,胶囊滞留率1.47%(3/203),只有1例患者最终发生急性肠梗阻。其他患者耐受性好。结论： 1.胶囊内镜是诊断小肠疾病有效的检查手段,胶囊内镜对小肠疾病的病变检出率及病因诊断率较高。前四位的病因诊断依次为小肠克罗恩病、血管畸形、小肠肿瘤、寄生虫病。 2.胶囊内镜对不明原因消化道出血组的病变检出率及病因诊断率均高于腹痛组,不明原因消化道出血组前四位的病因诊断依次是血管畸形、小肠肿瘤、小肠克罗恩病、小肠糜烂出血。 3.胃运行时间超过45min、小肠克罗恩病是小肠检查不完全的危险因素。 4.胶囊内镜对小肠疾病的病因诊断率高于全消化道钡餐、腹部CT；胶囊内镜联合全消化道钡餐或腹部CT检查均可提高诊断率。本研究中胶囊内镜与双气囊小肠镜对小肠疾病的病因诊断率相当。 5.胶囊内镜是一种较安全的检查方法,患者耐受好,并发症发生率低。
[Abstract]:Objective: To evaluate the diagnostic value and safety of domestic OMOM capsule endoscopy in small bowel diseases.
Methods: the clinical data of 208 patients with suspected small intestinal diseases, such as gastroscopy and colonoscopy, were reviewed from January 2011 to January 2014 in our hospital. The clinical data of 208 patients with suspected small intestinal diseases, which had no interpretable clinical symptoms, were examined, and the results of the OMOM capsule endoscopy were carried out to understand the accuracy of the diagnosis and the change of the disease. The diagnosis rate of intestinal diseases was compared with that of the whole digestive tract barium meal or abdominal CT or double balloon enteroscopy.
Result:
In 1.208 cases, 203 cases were successfully examined and the rate of examination success was 97.59% (203/208). The proportion of the elderly with OGIB was significantly higher than that of children, middle and young (64.06%vs34.72%), while in children, the proportion of abdominal pain was significantly higher in the middle and young people than in the elderly (56.25% vs31.25%).
The total detection rate of 2. capsule endoscopy for small intestinal lesions was 66.01% (134/203). The first four positive findings were small intestinal ulcer, mucosal inflammation, vascular malformation and occupying lesion. The total etiological diagnosis rate was 35.96% (73/203). The first four etiological diagnoses were small intestinal Crohn's disease, vascular malformation, small intestinal tumor, and parasitic disease.
3. capsule endoscopy for detection of intestinal diseases in each group:
(1) the detection results of the capsule endoscopy in the unexplained gastrointestinal bleeding group: the detection rate was 80.68% (71/88). The positive findings were mainly vascular malformation, occupying lesion, small intestinal ulcer and mucous membrane inflammation; the etiological diagnosis rate was 52.27% (46/88). The etiological diagnosis was mainly vascular malformation, small intestine tumor, and Crohn's disease of small intestine. The detection rate of the group was 55% (55/100). The positive findings were mainly small intestinal ulcer, mucous membrane inflammation, vascular disease and small intestinal diverticulum, the diagnosis rate was 23% (23/100). The etiological diagnosis mainly consisted of small intestine Crohn's disease, parasitic disease and small intestinal diverticulum, and the detection result of capsule endoscopy for diarrhea group was 61.. The detection rate of pathological changes was 61. 54% (8/13), most of the positive findings were mucosal inflammation and intestinal ulcers. The etiological diagnosis rate was 30.77% (4/13). The etiological diagnosis was small intestinal Crohn's disease and eosinophilic enteritis.
4. comparison of capsule endoscopy and whole gastrointestinal barium meal, abdominal CT and double balloon enteroscopy in the diagnosis of small bowel diseases:
The diagnostic rate of barium meal in the whole digestive tract was 8.04% (9/112) and capsule endoscopy 36.61% (41/112). The difference was statistically significant (P0.05). The diagnostic rate of the combined diagnosis was 38.39% (43/112), compared with the capsule endoscopy (P0.05); the diagnostic rate of abdominal CT was 16.67% (14/84) and capsule endoscopy 29.76% (25/84). The difference was statistically significant (P0.05). The diagnostic rate of the combined diagnosis was 32.14% (27/84), and the difference was statistically significant (P0.05) compared with the simple capsule endoscopy (P0.05); the etiological diagnosis rate of the double balloon enteroscopy was 53.85% (7/13), and the capsule endoscopy 53.85 (7/ 13) had no statistical difference (P0.05), and both were diagnosed jointly. The etiological diagnosis rate was 69.23% (9/13), and there was no significant difference compared with capsule endoscopy (P0.05).
5. the coincidence rate of endoscopic diagnosis and pathological diagnosis of capsule endoscopy was 66.67% (14/21), and the coincidence rate for small intestinal stromal tumors was 70% (7/10).
6. the total small bowel examination rate was 66.70% (136/203), and the gastric operation time was more than 45min. Crohn's disease of small intestine was a risk factor for complete small bowel examination without capsule endoscopy.
7. capsule endoscopes were tolerated and complications: 3 patients had capsule retention, the capsule retention rate was 1.47% (3/203), and only 1 patients eventually had acute intestinal obstruction. Other patients were well tolerated.
Conclusion:
1. capsule endoscopy is an effective method for the diagnosis of small intestinal diseases. The detection rate and the diagnostic rate of the disease are higher in capsule endoscopy. The first four etiological diagnoses are small intestinal Crohn's disease, vascular malformation, small intestinal tumor, and parasitic disease.
The detection rate and etiological diagnosis rate of the 2. capsule endoscopy were higher than those in the abdominal pain group. The first four of the unexplained gastrointestinal bleeding group were vascular malformation, small intestinal tumor, small intestine Crohn's disease, and intestinal erosion bleeding.
3. gastric operation time exceeds 45min. Crohn's disease is a risk factor for incomplete detection of small intestine.
The diagnostic rate of 4. capsule endoscopy is higher than the whole digestive tract barium meal, abdominal CT, capsule endoscopy combined with full gastrointestinal barium meal or abdominal CT examination can improve the diagnostic rate. In this study, the diagnosis rate of the capsule endoscopy and double balloon enteroscopy for the cause of small intestinal disease is equal.
5. capsule endoscopy is a safer method of examination. Patients are well tolerated and the incidence of complications is low.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R574

【参考文献】