胶囊内镜在儿童小肠疾病诊治中的应用价值

Clinical value of wireless capsule endoscopy in diagnosis of small bowel disease in children

目的对疑有小肠疾病的儿童进行胶囊内镜检查，评估胶囊内镜在儿科的应用价值以及安全性。方法对2004年6月-2008年6月疑有小肠疾病的住院和门诊儿童43例进行胶囊内镜检查，男28例，女15例，年龄6～18岁，体重15～60k，身高110—180cm，观察胶囊内镜检查成功率和失败率、胶囊内镜通过胃、小肠的平均时间，病变检出率和与最终诊断的符合率，操作过程中患者的耐受性和并发症；由胶囊内镜传送图像的质量评价；禁食8h后检测时小肠的清洁度。结果所有患儿均顺利吞服胶囊，检查期间耐受性好。共进行胶囊内镜检查46例次，成功43例次，失败3例次（成功率94％）；胶囊内镜通过胃的平均时间为73（3～600）min，小肠内平均运行时间为246（73～413）min；检出病变37例（90％），与最终诊断符合的为31例（84％），出现并发症1例（2％）；禁食8h，小肠的清洁度佳，胶囊内镜所获取图像质量良好。结论对于儿童不明原因的小肠疾病，特别是不明原因的小肠出血和小肠克罗恩病的诊断，胶囊内镜是一种安全和有效的检查方法。

Objective The pathological change of small bowel is difficult to examine because it is anatomically unique. The development of wireless capsule endoscopy provides an unique opportunity to visualize the entire small bowel in a minimally invasive manner. The aim of this study was to assess the safety and clinical value of wireless capsule endoscopy in children. Methods During the last 4 years （June, 2004-June, 2008 ）, 46 times of wireless capsule endoscopy were performed in 43 patients with suspected small bowel disease, including obscure gastrointestinal bleeding （ n = 11 ） , recurrent abdominal pain （ n = 20）, chronic diarrhea （ n = 9 ）, protein losing enteropathy （ n = 2 ）, recurrent vomiting （ n = 1 ）. Of the 43 cases, 28 were male and 15 were female, the age ranged from 6 to 18 years, 8 of these cases were 〈 10 years old. The weight of the patients ranged between 15 kg and 60 kg. The average time of capsule passing through the stomach and the small intestine, the tolerance to and complication of wireless capsule endoscopy in patients, the image quality of capsule endoscopy, and the cleanliness of small intestine after fasting for 8 hours were observed and recorded. Result All the patients could easily swallow the capsule and had good tolerance. The overall success rate was 94% （43/46）. The median time of capsule passing through the stomach and small intestine was 73 min （range, 3-600 min） and 246 min （range, 73-413 min）, respectively. The diagnostic yield of pathological change in small intestine was 90% （37/41）, and the diagnostic accordance rate was 84% （31/37）. Based on the wireless capsule endoscopy, diagnostic findings included Crohn＇ s diseases （ 15 ） , lymph follicular hyperplasia （ 4 ） , nonspecific enteritis （ 4 ） , vascular malformations （ 3 ） , small bowel tumour （ 2 ） , primary intestinal lymphangiectasia （ 2 ） , gastrointestinal motility disorders （ 2 ） , Meekel＇ s diverticulum （ 1 ） , angioma （ 1 ） , small intestinal worm disease （ 1 ） , duodenal ulcer （ 1 ） , and polyposis syndromes （ 1 ） . The capsule of 1 patient remained in the stomach. The cleanliness of small intestine after 8 hours fasting was good. And the capsule endoscopy can show high quality small intestine image. Conclusion Wireless capsule endoscopy is a noninvasive, safe and useful tool for the investigation of the small intestine in children, especially for obscure gastrointestinal bleeding and Crohn＇s disease.