胶囊内镜诊断不明原因消化道出血的价值

Diagnostic Value of Capsule Endoscopy in Obscure Gastrointestinal Bleeding

背景:不明原因消化道出血(OGIB)的诊断是临床难题之一。随着内镜技术的革新,OGIB的诊治水平不断提高。目的:评价胶囊内镜诊断OGIB的价值。方法:回顾性分析南京鼓楼医院2003年5月～2008年4月行胶囊内镜检查的OGIB患者的资料。结果:胶囊内镜的OGIB总检出率为82.6%(228/276)。小肠病变检出率为77.5%(214/276),其中以血管动静脉畸形(AVM)最为常见,其次为小肠占位和小肠克罗恩病(CD)。14例(5.1%)患者的出血部位位于小肠以外,其中5例位于胃内,9例为结肠病变。所有患者均未出现肠梗阻症状。与<50岁的患者相比,≥50岁者的小肠AVM检出率显著增高(33.9%对19.6%,P=0.016),小肠占位和寄生虫病检出率均无明显差异。男性患者的小肠CD检出率显著高于女性患者(17.1%对6.8%,P=0.018)。结论:胶囊内镜检查安全、无创伤,诊断OGIB的价值较高。OGIB以小肠AVM最为多见,其次为小肠占位和CD。

Background： Diagnosis of obscure gastrointestinal bleeding （OGIB） is one of the most difficult problems clinically. The diagnosis and treatment of OGIB have been continuously improved since the innovation of endoscopy. Aims： To evaluate the value of capsule endoscopy in the diagnosis of OGIB. Methods： Data of OGIB patients undergone capsule endoscopy in Nanjing DrumTower Hospital from May 2003 to April 2008 were reviewed retrospectively. Results： The overall detection rate of OGIB by capsule endoscopy was 82.6% （228/276）, that of small intestinal lesions was 77.5% （214/276）. Of all the small intestinal lesions, arteriovenous malformation （AVM） was most common, followed by small intestinal space-occupying lesion, and Crohn＇s disease （CD）. Five cases had lesions within the stomach and 9 were in the colon. Bowel obstruction was not found in any patients. The detection rate of intestinal AVM in ≥ 50-year-old patients was significantly higher than that in 〈50-year-old patients （P=0.016）, while no significant differences were found in detection rates of small intestinal space-occupying lesion and parasitic disease between ≥50-year-old patients and 〈50-year-old patients. Detection rate of small bowel CD in male patients was significantly higher than that in female patients （17.1% vs. 6.8%, P=0.018）. Conclusions： Capsule endoscopy has the advantages of safety, non-invasiveness and higher diagnostic value in the detection of OGIB. AVM is the most commonly seen cause of OGIB, followed by small intestine spaceoccupying lesion and CD.