双气囊小肠镜在小肠出血患者治疗中的应用价值及安全性研究

发布时间：2018-09-14 13:15

【摘要】：目的探讨双气囊小肠镜(DBE)在小肠出血(SBB)患者治疗中的应用价值及安全性,分析SBB患者的病因特点。方法收集2015年6月-2016年7月南京医科大学第二附属医院诊断为SBB的52例接受DBE检查的患者资料,回顾性分析诊治结果及并发症发生和随访情况。结果该研究共纳入患者52例(男28例,女24例),年龄16~82(51.0±17.0)岁,发病时间1~14(8.3±4.0)d。显性消化道出血37例,隐性消化道出血15例。经口进镜25例,经肛进镜21例,经结肠造瘘口进镜2例,口+肛4例。DBE的诊断率为76.9%(40/52),并发症发生率为5.8%(3/52),小肠镜检查阴性患者小肠再出血率16.7%(2/12)。5例小肠多发性息肉予以内镜黏膜切除术(EMR),2例小肠毛细血管扩张症给予氩离子凝固术(APC)。1例空肠癌伴胶囊滞留予以取出胶囊,14例(26.9%)接受手术治疗。SBB病因为肿瘤(n=9,17.3%)、溃疡(n=9,17.3%)、克罗恩病(n=7,13.5%)、息肉(n=5,9.6%),憩室/血管畸形(n=4,7.7%)等。SBB患者中位随访时间(8.3±2.0)个月,范围4~10个月,死亡2例,死因为小肠癌再出血。结论 DBE诊断SBB及行内镜下治疗安全有效,即使在困难病例Roux-en-Y术后。SBB病因以肿瘤、溃疡、克罗恩病较为常见,小肠镜检查阴性患者仍有小肠再出血可能,血管病变可能性大。
[Abstract]:Objective to evaluate the clinical value and safety of double balloon enteroscopy (DBE) in the treatment of small intestinal hemorrhage (SBB) and to analyze the etiological characteristics of SBB. Methods from June 2015 to July 2016, 52 patients with SBB diagnosed in the second affiliated Hospital of Nanjing Medical University were examined by DBE. The results of diagnosis and treatment, the occurrence and follow-up of complications were analyzed retrospectively. Results A total of 52 patients (M 28, F 24) were enrolled in this study. The age was 161.0 卤17.0 years old and the onset time was 1: 14 (8.3 卤4.0) days. There were 37 cases of dominant gastrointestinal bleeding and 15 cases of recessive gastrointestinal bleeding. There were 25 cases of transoral endoscopy, 21 cases of transanal endoscopy and 2 cases of colostomy. The diagnostic rate of .DBE was 76.9% (40 / 52), the incidence of complications was 5.8% (3 / 52). The rate of small intestinal rebleeding in patients with negative enteroscopy was 16.7% (2 / 12). 5 cases of multiple polyps were treated with endoscopic mucosal excision. 2 cases of small intestine capillary dilatation were treated with argon ion coagulation. 14 cases (26.9%) underwent surgical treatment. The etiology of (APC) was tumor (917.3%), ulcer (917.3%), Crohn's disease (713.5%), polyp (59.6%), diverticulum / vascular malformation (47.7%) and so on. The median follow-up time was (8.3 卤2.0) months. The range of 4 ~ 10 months, 2 cases of death, because of small bowel cancer bleeding again. Conclusion DBE is safe and effective in the diagnosis of SBB and endoscopic treatment. Even if the etiology of Roux-en-Y after Roux-en-Y is tumor, ulcer and Crohn's disease, the patients with negative enteroscopy still have the possibility of small intestinal rebleeding and the possibility of angiopathy.
【作者单位】：安徽省宿州市立医院消化内科;南京医科大学第二附属医院消化医学中心;
【分类号】：R574.5

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