双气囊小肠镜在胶囊内镜检查阴性小肠疾病诊断中的作用

Capsule Endoscopy Diagnosis of Negative Small Bowel Disease's Clinical Analysis

目的通过双气囊小肠镜对胶囊内镜检查阴性疾病的诊断,探讨胶囊内镜在不同小肠病变的诊断作用。方法对156例疑诊为小肠疾病患者行胶囊内镜检查,随后对87例阴性患者进一步行双气囊小肠镜检查。结果156例患者中69例胶囊内镜检查阳性,其中不明原因消化道出血52例,有警报症状和体征17例,总体阳性诊断率44.2%(69/156),检出的主要病变有:小肠炎症(粘膜糜烂、溃疡)32例,小肠肿瘤24例,小肠血管发育不良9例,小肠憩室1例,白塞病2例,小肠结核钙化灶1例。87例胶囊内镜检查阴性患者经双气囊小肠镜检查额外检出小肠病变12例,对于胶囊内镜检查阴性患者双气囊小肠镜诊断率为13.8%(12/87),其中不明原因消化道出血9例,有警报症状和体征3例,检出病变有:小肠憩室5例,小肠血管发育不良4例,小肠溃疡1例,小肠肿瘤2例。结论胶囊内镜对于表现为隆起性、浸润性、溃疡和多发性病灶小肠疾病具有较高的的诊断能力,但对小肠憩室和病变局限病灶较小的小肠血管发育异常者诊断能力有限,与双气囊小肠镜有效结合运用能大为提高小肠疾病的诊断率和准确性。

Objective：Through the double-balloon enteroscopy diagnosis of the capsule endoscopy negative disease, discussion the diagnosis of capsule endoscopy in different small intestine disease. Methods：Examine 156 suspected patients with intestinal diseases by capsule endoscopy, and then examine 87 negative cases by double-balloon enteroscopy. Results： There are 69 of the 156 cases patients＇ capsule endoscopy examinations were positive, including 52 cases of unexplained gastrointestinal bleeding, and 17 cases with warning signs and symptoms. The positive diagnostic rate is 44.2% （69/156）, and the main diseases detected are： 32 cases of small intestine inflammation （mueosal erosion, ulcers）, 24 cases of intestinal tumor, 9 cases of intestinal vascular dysplasia, diverticula of intestine one case, Behcet＇s disease two cases, and one case of small intestine tuberculosis calcified lesions. 12 cases of intestinal disease were detected by the double-balloon enteroscopy form 87 cases of capsule endoscopy-negative patients, the double-balloon enteroscopy positive diagnostic rate of the capsule endoscopy-negative patients was 13.8% （12/87）, including 9 cases of unexplained gastrointestinal bleeding, and 3 cases with warning signs and symptoms, the diseases detected are： diverticula of intestine five cases, small intestine vascular dysplasia four cases, small intestinal ulcer one case, and two cases of intestinal cancer. Conclusion： Capsule endoscopy has a high diagnostic capacity for prominent, infiltrating, ulcerative and multiple lesions of small intestine disease, but which is limitated in diagnosis of diverticula of intestine and intestinal vascular dysplasia with small lesions. There will be a greatly improve in diagnosis and accuracy of intestinal diseases, if it is effective combined with double- balloon enteroscopy.