1.4 m内镜对空肠上段病变的诊治价值

Diagnostic and therapeutic value of 1.4-metre colonoscope for upper jejunum lesions

目的 探讨1.4 m内镜对空肠上段病变的诊治价值.方法 选择2008年至2009年间,对疑为空肠上段出血或其他上消化道疾病,并已行一次或一次以上内镜检查和全消化道钡餐检查而未发现确切病变者作为实验组,共115例,均换用1.4 m内镜检查,至十二指肠降段后,再尽量深插至空肠上段,如发现病变,对其进行活检或治疗.选择2004年至2007年间与实验组病情条件类似者115例作为对照组,仍采用胃镜检查,经同样方法进行诊治.结果 实验组和对照组均成功插镜至十二指肠降部.实验组和对照组插至十二指肠水平部分别是112例和107例,插至升部分别是109例和72例,插至近段空肠分别是102例和35例.实验组插至十二指肠水平部、升部和近段空肠的成功率分别为97.39%、94.78%和88.70%;对照组分别为93.04%、62.61%和30.43%,实验组和对照组插镜成功率,在十二指肠水平段组间差异无统计学意义（P＞0.05）,在十二指肠升部和近段空肠差异均有统计学意义（P均＜0.005）.实验组共发现病变31例（26.96%）,对照组共发现病变6例（5.22%）,组间诊断率差异有统计学意义（P＜0.005）.实验组成功活检或内镜下治疗20例,其中12例占位性病变其病理和位置与术后基本一致;对照组成功活检证实水平部间质瘤、腺癌和P-J综合征各1例,钩虫病3例.结论 1.4 m内镜能比胃镜更深入地插入空肠,对十二指肠降段以下尤其是空肠上段出血患者具有较好的诊治价值.

Objective To study the diagnostic and therapeutic value of 1.4-metre colonoscope for upper jejunum lesions. Methods From 2008 to 2009, patients with suspected upper jejunum lesions, who presented as obscure gastrointestinal bleeding or other digestive symptoms and got no definite diagnosis from gastroscopy and entire digestive tract barium meal, were recruited as experimental group （n = 115） and underwent an examination with 1.4-metre endoscope. The endoscope was inserted into proximal jejunum, biopsy or treatment was performed according to the found lesions. Another 115 patients from 2004 to 2007, who presented with similar situation but were examined with gastroscope, were recruited as control group. Results Descending duodenum was accessed successfully in all cases from 2 groups. Horizontal duodenum was accessed in 112 and 107 cases of experimental group and control, respectively （97. 39% vs. 93.04%, P 〉0. 05）, while the ascending part was accessed in 109 and 72 cases, respectively （94.78% vs. 62.61%, P〈0.005）, and the proximal jejunum was accessed in 102 and 35 cases, respectively （88.70% vs. 30. 43%, P 〈 0. 005）. A total of 31 （26. 96%） lesions were found in experimental group, which was significantly higher than that in control group （6/115, 5.22%, P 〈0.005）. Biopsy or endoscopic management was performed in 20 cases from experimental group, in which 12 occupying lesions were confirmed by pathology and surgery. In control group, 1 case of stromal tumor, 1 adenocarcinma, 1 P-J syndrome and 3 ancylostomiasis at horizontal duodenum were confirmed. Conclusion 1.4-metre endoscope can be inserted deeper than gastroscope, and is of better diagnostic value for bleeding in descending duodenum, especially in upper jejunum.