双气囊小肠镜诊断不完全性小肠梗阻

Value of double-balloon enteroscopy in diagnosing partial small bowel obstruction

目的:评价双气囊小肠镜(DBE)在不完全性小肠梗阻诊断中的作用。方法:2004年12月至2006年1月,我院经临床及影像学检查明确诊断的不完全性小肠梗阻患者45例,除外高度怀疑为术后粘连引起的不完全小肠梗阻者,对其余病情稳定的患者行DBE检查,收集并分析相关临床观察数据。结果:对29例患者进行了30次DBE检查,其中27例(93.1%)经DBE检查明确了梗阻原因,17例(58.6%)获得病理学诊断依据。发现可解释小肠不完全梗阻的病因中,小肠肿瘤占48.3%;克罗恩病所致肠腔狭窄占24.1%。DBE诊断小肠不完全梗阻病因的灵敏度为96.4%,特异度为100%,阳性预测值为100%,阴性预测值为50%。26例(89.7%)患者平均随访9.4个月(4～18个月),其中21例(72.4%)未再出现小肠梗阻。结论:DBE检查对非手术粘连引起的不完全性小肠梗阻具较高的诊断价值,是一项安全可行的检查方法。

Objective To evaluate the value of double-balloon enteroscopy （DBE） in diagnosing partial small bowel obstruction （SBO）. Methods Forty-five consecutive patients in our hospital from Dec 2004 to Jan 2006 with partial SBO confirmed by both clinical symptoms and imaging examinations were enrolled. The patients with highly suspected postoperative adhesion were excluded and DBE was performed in the stable patients. Demographic, clinical, procedural and outcome data were collected for analysis. Results A total of 30 DBEs were performed in 29 patients [11 women, 18 men; age （52＋13） years]. The causes of partial SBO were identified through DBE in 27 patients （93.1%） and through histopathologic evaluation in 17 patients （58.6%）. The common abnormalities detected were small bowel tumors （48.3%） and strictures caused by Crohn＇s disease （24.1%）. In detecting small bowel abnormalities, DBE had a sensitivity of 96.4%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 50%. The follow-up data was obtained in 26 patients （89.7%）, with the mean （range） duration of 9.4 month （4-18months）. Among the 26 patients with follow-up data, 21 （72.4%） had no re-onset of SBO. Conclusions DBE is a feasible diagnostic tool for detecting the causes of partial SBO in the patients without an abdominal surgical history.