354例不明原因消化道出血患者的诊断及病因分析

Endoscopic diagnosis and etiological factor of obscure gastrointestinal bleeding in 354 caese

目的评价双气囊电子小肠镜及胶囊内镜对不明原因消化道出血的诊断价值、安全性及耐受性。方法2006年10月至2008年11月,354例患者因黑便或便血就诊。其中152例接受双气囊电子小肠镜检查,202例接受胶囊内镜检查。结果双气囊小肠镜病变检出率为82.24%(125/152),胶囊内镜病变检出率为71.78%(145/202)。双气囊小肠镜组病变检出率显著高于胶囊内镜组(P<0.05)。双气囊小肠镜组病因诊断准确率(85.1%)显著高于胶囊内镜组(31.2%)(P<0.01)。除2例患者未完成胶囊内镜外,其余所有患者均顺利完成检查,未发生并发症,也未出现麻醉并发症或麻醉意外。结论双气囊电子小肠镜和胶囊内镜对不明原因消化道出血有较高诊断价值,是安全、可靠的检查手段,但双气囊小肠镜组的病变检出率及诊断率均显著高于胶囊内镜组。

Objective To evaluate the significance of the double balloon endoscopy and capsule endoscopy in the diagnosis of obscure gastrointestinal bleeding. Methods From October 2006 to November 2008,there were 354 patients（214 men, 140 women; mean age of 49.9 years, range 13--88 years） with obscure gastrointestinal bleeding;152 patients were performed double balloon endoscopy and 202 were performed capsule endoscopy. Results The bleeding sources were identified with a positive rate of 82.24% （125/152） and 71.78 % （145/202） respectively by double balloon endoscopy and capsule endoscopy. The etiological diagnostic accuracy of double balloon endoscopy was 85.1%,and 31.2% for capsule endoscopy. All patients were well tolerated except 2 did not accomplish capsule endoscopy. Conclusion Double balloon endoscopy and capsule endoscopy are both effective and safe method for the diagnosis of obscure gastrointestinal bleeding. But double balloon endoscopy is superior to capsule endoscopy in the diagnostic yield and the etiological diagnosis.