双气囊小肠镜在诊断小肠克罗恩病中的价值

Double balloon enteroscopy in diagnosis of small bowel Crohn’s disease

目的探讨双气囊小肠镜在诊断小肠克罗恩病中的价值。方法对65例临床怀疑小肠克罗恩病的患者进行检查,并与先前进行的插管法小肠钡灌肠和胶囊内镜检查结果进行对比分析。结果65例患者行双气囊小肠镜检查诊断为小肠克罗恩病58例,并经病理和临床随访确诊。其中45例患者首选从肛门进镜行小肠镜检查,确认克罗恩病34例(75·6%),另11例后从口腔进镜,发现病变者8例(72·7%);20例首选经口进镜,检出克罗恩病11例(55%),另9例患者日后经肛进镜检查中检出5例(55·6%)。先前进行的46例小肠钡灌肠检查中,24例诊断或疑似小肠克罗恩病,诊断率为52·2%,与小肠镜结果比较,符合小肠克罗恩病诊断例数为18例,诊断正确率为75%(18/24)。22例胶囊内镜检查者中,14例诊断或疑似小肠克罗恩病,诊断率为63·6%,最终经双气囊小肠镜确诊的病例数为11例,诊断准确率为78·6%(11/14)。结论经口和经肛方式结合能使双气囊小肠镜完成对全小肠的检查;双气囊小肠镜是小肠克罗恩病诊断的较为理想的方法,并能对病变范围和严重程度作出正确判断,插管法小肠钡灌肠是一项决定小肠镜进镜方式选择上有价值的筛选性手段。

Objective To evaluate the diagnostic efficiency of double-balloon enteroscopy in small bowel Crohn＇ s disease. Methods In sixty five patients with suspected small bowel Crohn＇s disease doubleballoon enteroscopy were performed, and some of them received enteroscopy and enteroclysis, capsule endoscopy as well. Results The first enteroscopy was performed via mouth in 20 of 65 cases, and the lesions were detected in 11 cases （55%） , 5 of 9 cases（55.6% ） had lesions detected in enteroscopy via anus while nothing was found in mouth route. Among 45 cases examed by enteroscopy firstly via anus, 34 cases had lesions detected （ 75.6% ） , 8 of 11 cases（ 72. 7% ） had lesions found in following exam via mouth. Totally 58of 65 had lesions detected through enterosocpy examination, the overall diagnostic yield was 89. 2%. Twenty four of 46 cases had positive findings with enteroclysis. The diagnosis of Crohn＇s disease was comfirmed in 14 of 22 patients（63.6% ） underwent capsule endoscoy. The diagnosis was finally confirmed by enteroscopy only in 11 patients （ 78.6% ）. Conclusion The entire small intestine could be examined by enteroscopy with combination of mouth and anus route. Double-balloon enteroscopy was an ideal diagnostic modality for small bowel Crohn＇s diseases, which was also valuable in assessment on extent and severity of the disease. Small bowel enteroclysis was a useful screening alternative for selecting procedure route in DBE.