磁控胶囊内镜三种不同胃准备方案的随机对照研究

发布时间：2018-10-31 10:44

【摘要】：目的:通过采用三种不同的胃准备方案进行磁控胶囊内镜(MCE)检查,通过对MCE图像检查质量、患者耐受度、阳性病灶检出情况及安全性评估,探讨最适宜MCE检查的胃准备方案。方法:2016年6月至2016年10月纳入行MCE检查者120例,所有受检者需检查前禁食8h,检查前将其随机分成3组:A组清水组(40例);B组西甲硅油组(40例);C组西甲硅油+链霉蛋白酶联用组(40例)。分析比较三组受检者胃内准备的清洁度和显示度的评分、患者耐受度、阳性病灶检出情况及安全性等指标的差异。结果:1.本研究共计纳入的120例受检者,其中男性72例,女性48例,平均年龄47.05(20-74)岁,平均BMI 23.04±3.88 kg/m2,平均腰围82.37±11.31cm。三组患者在年龄、性别、BMI、腰围等基本资料无显著性差异(P0.05)。此外,120例受检者中,腹痛53例(44.1%),腹胀14例(11.7%),反酸恶心12例(10.0%),不明原因消化道出血或缺铁性贫血9例(7.5%),健康体检者32例(26.7%)。2.主要研究指标:胃内准备图像质量,主要包括清洁度及显示度的评估。三组的清洁度总体(贲门、胃底、胃体、胃角、胃窦、幽门6个主要解剖标志部位)评分分别为,A组15.83±2.41,B组21.35±1.23,C组20.82±1.90,其中A组与B组、A组与C组均具有统计学差异(P值均小于0.0001),而B组与C组无统计学差异(P0.05)。三组之间的显示度总体(同上)评分分别为,A组10.75±2.02,B组15.20±1.32,C组15.08±1.86,其中A组与B组及C组均具有统计学差异(P值均小于0.0001),而B组与C组无统计学差异(P0.05)。3.次要研究指标:MCE阳性病灶(包括浅表性胃炎、糜烂性胃炎、胃息肉、胃溃疡、胃癌)病灶检出的情况,依次为A组21(52.5%),B组27(67.5%),C组21(53.8%),三组阳性病灶检出率无统计学差异。其中,A组1例患者在MCE下诊断为胃恶性溃疡,后行普通胃镜复查取病理活检证实为胃印戒细胞癌。该患者在2月后死亡。4.安全性指标:纳入的120例受试者均顺利完成检查,检查过程中仅有1例(1/120,0.8%)患者因幽门的炎症性水肿引起的幽门狭窄,导致胶囊无法通过胃腔,后行电子胃镜取出。其余患者在检查过程中及检查结束后的2周随访过程中无明显不适及不良事件发生。结论:西甲硅油+清水方案相对于单用清水方案而言,可显著提高磁控胶囊内镜检查的胃准备效果,而加用链霉蛋白酶并没有显著提高胃粘膜的清洁度及可视度。因此我们推荐磁控胶囊内镜胃准备过程中采用西甲硅油+清水方案作为胃准备的常规方案。
[Abstract]:Objective: to evaluate the quality of MCE image, patient tolerance, positive lesion detection and safety by using three different gastric preparation schemes for magnetic controlled capsule endoscopy (MCE). To explore the most suitable gastric preparation scheme for MCE examination. Methods: from June 2016 to October 2016, 120 patients underwent MCE examination. All the subjects had to fast for 8 hours before examination. They were randomly divided into three groups: group A, clear water group (40 cases,); B group, 40 cases); Group C (40 cases) were treated with strepsin. The scores of cleanliness and display degree of gastric preparation, patient tolerance, positive lesion detection and safety were analyzed and compared among the three groups. The result is 1: 1. A total of 120 subjects were included in this study, including 72 males and 48 females, with an average age of 47.05 (20-74) years and an average BMI of 23.04 卤3.88 kg/m2, with an average waist circumference of 82.37 卤11.31 cm. There was no significant difference in age, sex and BMI, waist circumference among the three groups (P0.05). In addition, there were 53 cases of abdominal pain (44.1%), 14 cases of abdominal distension (11.7%), 12 cases of acid regurgitation (10.0%), 9 cases of unknown gastrointestinal bleeding or iron deficiency anemia (7.5%). 32 cases (26.7%) were healthy. Main outcome measures: image quality of gastric preparation, including the assessment of cleanliness and display. The total cleanliness of the three groups (cardia, fundus, body, angle, antrum and pylorus) were 15.83 卤2.41 and 21.35 卤1.23 in group B, 20.82 卤1.90 in group A and B, respectively. There was statistical difference between group A and group C (P < 0.0001), but there was no statistical difference between group B and group C (P0.05). The overall (ibid.) scores of the three groups were as follows: group A, 10.75 卤2.02mb, group B, 15.20 卤1.32, group C 15.08 卤1.86.The difference between group A and group B and group C was statistically significant (P < 0.0001). There was no statistical difference between group B and group C (P0.05). Secondary outcome measures: MCE positive lesions (including superficial gastritis, erosive gastritis, gastric polyp, gastric ulcer, gastric cancer) were detected in group A 21 (52.5%), B 27 (67.5%). In group C, 21 (53.8%), there was no significant difference in the detection rate of positive lesions among the three groups. One patient in group A was diagnosed as gastric malignant ulcer under MCE, and then confirmed as gastric signet ring cell carcinoma by general gastroscopy. The patient died two months later. Safety measures: all 120 subjects successfully completed the examination. During the examination, only one patient (1 / 1200.8%) had pyloric stenosis caused by inflammatory edema of the pylorus, resulting in the capsule being unable to pass through the stomach cavity. After the electronic gastroscope removed. No significant discomfort or adverse events occurred in the other patients during the examination and 2 weeks follow-up after the examination. Conclusion: compared with the single use of clear water, the methylene silicone oil regimen can significantly improve the gastric preparation effect of magnetic control capsule endoscopy, but the addition of strepsin did not significantly improve the cleanliness and visibility of gastric mucosa. Therefore, we recommend the use of methylsiloxane oil as a routine regimen for gastric preparation during endoscopic gastric preparation of Magnetron capsule.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R573

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