胶囊内镜小肠病灶定位方法及其临床价值研究

A predictive method of small intestinal lesion location with wireless capsule endoscopy

目的 运用散点图模拟胶囊内镜在小肠内运行规律探讨定位小肠病灶的方法及其临床应用价值.方法 连续选择由胶囊内镜诊断且病灶经手术证实的患者30例纳入A组,以胶囊自屈氏韧带至病灶的运行时间占通过全小肠所用时间的百分比定义为时间指数,设为横坐标,而将手术中测得的病灶距屈氏韧带的实际距离设为纵坐标,画出散点图并拟合得出最佳曲线的函数方程.以相同的入选标准连续选择患者30例纳入B组,验证上述曲线方程的准确性.结果 A组30例患者所得散点图采用拟合度最好、最符合小肠蠕动客观规律的二次方程模型拟合,以该曲线方程验证B组30例患者,计算误差范围.结果 显示最小误差0.79 cm,最大误差41.49 cm,平均误差（19.64±13.98）cm 误差≤20 cm者达50%（15/30）,误差≤30 cm者达67%（20/30）,误差≤50 cm者达100%（30/30）.结论 时间定位法能较为准确地定位病灶,为小肠病灶定位提供判断依据,使胶囊内镜的诊断功能更趋完善.

Objective To investigate the method of locating intestinal lesions by scatter diagram which simulating the movement of capsule endoscopy in small intestine and its significance. Methods A total of 30 consecutive patients with lesions in small intestine which was diagnosed by wireless capsule endoscopy （WCE） and confirmed by following surgery were enrolled in the study as group A. The time index was defined as the ratio of the transition time from the duodenojejunal flexure to the lesion to that to the ileocaecal valve. For each case in group A, the time index was marked on a horizontal axis with the distance between duodenojejunal flexure and the lesion on a vertical axis. The best curve was obtained to simulate the intestinal movement, and 30 other patients selected by the same criteria were used as group B to testify the accuracy of the curve. Results Parabola and quadratic equation were obtained from group A to simulate the intestinal peristalsis. Calculation of errors in group B showed a minimal error of 0. 79 cm, a maximal error of 41.49 cm and a mean error of （ 19. 64± 13. 98 ） cm. Patients with errors less than 20 cm accounted for 50%（15/30）, those with errors less than 30 cm were 67% （20/30）, and those with errors less than 50 cm amounted to 100% （30/30）. Conclusion Locating the lesion in small intestine by transition time of WCE is of high accuracy and is able to facilitating the diagnosis yield of WCE.