双气囊小肠镜与腹部CT在小肠疾病诊断中的临床价值

Diagnostic values of double-balloon enteroscopy and abdominal computed tomography in small bowel disease

目的探讨和比较双气囊小肠镜（DBE）与腹部CT对小肠疾病的诊断价值。方法2007年1月至2008年1月，共对70例疑患小肠疾病者行78次DBE检查，所有患者同时行CT检查。两组资料行配对四格表资料的χ^2检验或Fisher精确概率检验。结果70例患者DBE诊断阳性率明显高于CT[57．1％（40／70）VS31．4％（22／70），P〈0．01]。对于黏膜面的炎症、糜烂等病变，DBE诊断阳性率高于CT，差异均有统计学意义（血管畸形4／6 vs 0／6，小肠憩室1／3 vs 0／3，过敏性紫癜2／2 vs 0／2，非特异性炎2／2 vs 0／2，P〈0．01）；而对于肿瘤和克罗恩病，DBE的诊断阳性率与CT相比，差异并无统计学意义（P〉0．05）。结论DBE可作为小肠疾病较好的检查方式，CT可为DBE检查途径提供参考，且可了解小肠壁及肠外情况。DBE和CT在检查小肠疾病时可优势互补，建议对疑患小肠疾病者进行联合检查。

Objective To evaluate the diagnostic values of double-balloon enteroscopy （DBE） and abdominal computed tomography （CT） in small bowel disease. Methods Seventy eight DBE procedures were carried out in 70 patients, 40 males and 30 females ; aged 47.7 （ 16 - 83 ） with suspected small bowel disease, all of whom received gastroscopy, colonoseopy, and abdominal CT examination at the same time. The diagnostic value of DBE was compared with that of CT. Results Seventeen kinds of small bowel lesions were detected, mainly including Crohn＇ s disease, adenocarcinoma, gastrointestinal stroma tumor, vascular deformity, lymphoma, diverticulum, and polyp. There were no complications and all procedures were tolerated well. The mean duration of procedure was 110 rain （30-240 min）. Nineteen patients received surgical intervention. The diagnostic yield rate of DBE was 57.1% （40/70）, significantly higher than that of CT （31.4% , 22/70, P 〈0.01 ）. The positive diagnosis rate of DBE combined with CT was 62.9% （44/ 70）, not significant different from that of the DBE alone （P 〉 0. 05 ）. Conclusion DBE shows a significantly higher diagnostic yield than CT in patients with suspected small bowel disease, and thus should be selected for the initial diagnosis. DBE Combined with CT did not increase the diagnostic yield. However, CT not only provides direction of intubation for DBE, but also clearly depicts the small bowel wall and extraenteric alterations. DBE and CT compliment each other in examining the patients with suspected small bowel disease.