胶囊内镜在老年人不明原因消化道出血中的应用价值

Clinical application of wireless capsule endoscopy in the diagnosis of obscure gastrointestinal bleeding in the elderly

目的通过分析老年不明原因消化道出血（OGIB）患者的临床资料和胶囊内镜检查结果，探讨胶囊内镜在老年OGIB患者中的应用价值。方法分析比较2002年5月至2007年2月，因OGIB在我院行胶囊内镜检查的老年患者及非老年患者的一般资料、出血类型及检查结果。老年组97例，男性40例、女性57例，平均年龄（70，8±6．8）岁；非老年组99例，男性61例、女性38例，平均年龄（44．4±10．3）岁。结果老年组显性出血89例，隐性出血8例；非老年组分别为91例和8例。两组胃排空时间、全小肠检查完成率及胶囊延迟率，差异均无统计学意义，老年组小肠转运时间较非老年组显著延长（P〈0．05）。老年组2例因胶囊内镜滞留于食管未纳入诊断统计，老年组获阳性诊断62例（65．3％），血管病变为最常见病因；非老年组获阳性诊断67例（67.7％），小肠克罗恩病为最常见病因。两组获得阳性诊断率差异无统计学意义，阳性诊断构成比差异有统计学意义（P〈0．01）。老年组未发现并发症。结论胶囊内镜检查对老年OGIB患者是一项安全有效的检查手段，血管病变为老年OGIB患者最常见的病因。

Objective To evaluate the safety and effectiveness of capsule endoscopy（CE） in a large cohort of the elderly patients with obscure gastrointestinal bleeding（OGIB）. Methods The demographic, clinical and diagnostic data of all geriatric patients with obscure gastrointestinal bleeding who underwent CE between May 2002 and February 2007 were retrospectively analyzed. For comparison, non-geriatric patients with obscure gastrointestinal bleeding who underwent CE during the same period were selected as the control group. Results Ninety-seven geriatric patients C40 men/57 women, mean age （70.8 ± 6.8） yrs3 and ninety-nine non-geriatric patients C61 men/38 women, mean age （44.4 ± 10.3） yrs3were retrospectively reviewed. Eighty-nine patients presented with overt OGIB while eight patients had occult OGIB in the geriatric group. The section in the nongeriatric group was ninety-one and eight respectively. No significance was seen in the gastric transit time, completion rate and delay rate between two groups. The small bowel transit time was significantly longer in the geriatric group than that in the non-geriatric group （P〈0.05）. Sixty-two patients in the geriatric group obtained positive diagnosis and angiodysplasia was the most frequent lesion; while sixty-seven patients in the non-geriatric group obtained positive diagnosis and Crohn＇s disease was the most frequent lesion. No significance was seen in the positive diagnostic rate between two groups （P〉0. 05）. However, the constituent ratio of the positive diagnosis was significantly different between two groups （P〈0.01）. Conclusions CE is a safe and effective procedure for geriatric patients with obscure gastrointestinal bleeding. Angioectasia accounts for the majority of positive findings in geriatric group.