不明原因消化道出血的临床特点对气囊辅助小肠镜进镜路径选择的指导意义

Significance of the clinical characteristics of obscure gastrointestinal bleeding in selecting the best route of insertion for balloon assisted enteroscopy

目的探讨不明原因消化道出血临床特点对指导选择气囊辅助小肠镜进镜途径的作用和临床意义。方法回顾性分析空军总医院2003年9月—2015年3月因不明原因消化道出血(obscure gastrointestinal bleeding,OGIB)行气囊辅助小肠镜(balloon assisted enteroscopy,BAE)检查的222例住院患者临床资料,按进镜途径的不同,分为经口进镜组和经肛进镜组,比较分析2组患者的临床特点、BAE检查结果和并发症。结果接受BAE检查的222例OGIB患者中,130例发现病变,病变总检出率为58.56%(130/222)。结果显示,临床表现以黑便为主者,尤其首次大便为柏油样黑便者选择经口进镜病变检出率明显高于经肛进镜;而以暗红色血便或鲜血便为主者,经肛进镜较经口进镜病变检出率高,二者差异有统计学意义(P<0.05)。结论对于OGIB患者行BAE检查前,依据大便颜色改变情况选择进镜途径,可有效提高单侧进镜发现小肠出血病变的检出率。

Objective To investigate the clinical effect and significance of clinical characteristics of patients with obscure gastrointestinal bleeding （OGIB） in selecting the route of insertion for balloon assisted enteroscopy （BAE）. Methods Data of 222 inpatients with OGIB from the Air Force General Hospital who had undergone BAE between September 2003 and March 2015 were retrospectively analyzed. They were classified into two groups： anterograde approach and retrograde approach. The clinical features and outcomes of BAE and complications were compared. Results The overall diagnostic yield of BAE was 130 lesions （58.56%）. Our results showed that patients with melena, especially with tarry stools, had a higher diagnostic yield with the transoral approach, while the transanal approach worked better for maroon-colored stools or bright red stools. The difference was statistically significant （P〈0.05）. Conclusion For patients of OGIB, the color of stools can determine the route of insertion, which can improve the detection rate of bleeding lesion efficiently.