胶囊内镜在不明原因严重的消化道出血中的诊断作用

Capsule endoscopy in severe obscure gastrointestinal bleeding

目的探讨胶囊内镜(CE)在不明原因严重的消化道出血(OGIB)中的诊断作用。方法回顾性分析该院胶囊内镜检查的12例不明原因严重的消化道出血患者的临床资料。结果 12例患者均顺利完成检查,平均通过小肠时间为261min,其中2例(13.3%)未通过回盲瓣。共检出小肠病变10例,胶囊内镜的阳性率为83%。病因包括:毛细血管扩张2例(13.3%),毛细血管瘤1例(6.7%),动静脉畸形1例(6.7%),小肠多发溃疡2例(13.3%),小肠淋巴管扩张并出血1例(6.7%),小肠肿瘤3例(25%)。结论胶囊内镜检查耐受性好,安全、有效,诊断不明原因的严重消化道出血价值高。OGIB以小肠血管损伤最常见,其次为小肠肿瘤。

[Objective] Capsule endoscopy（CE） improves the diagnostic yield in patients with obscure gastrointestinal（GI） bleeding.The present study was to assess the diagnostic yield of CE in severe obscure gastrointestinal bleeding（OGIB）.[Materials] 12 capsule examinations were carried out in 12 patients with severe bleeding,defined as hemodynamic instability and the need for significant red blood cell transfusion.CE was carried out after upper and lower endoscopy failed to reveal a source of bleeding.[Results] 12 patients were successfully examined.The mean time for capsule getting into the small intestinal duct was 261 minutes,with capsule in 2 patients（13.3%） failing to get through ileocecal valve in the working time of capsule.Positive CE findings were found in 10（83%） patients.The etiology of bleeding included：telangiectasia in two patients（13.3%）,hemangiomas in one patient（6.7%）,arteriovenous malformation in one patient（6.7%）,multiple small bowel ulcers in two patients（13.3%）,lymphagiectasis in one patient（6.7%）,small bowel tumor in three patients（25%）.CE was not associated with increased morbidity or mortality rate.[Conclusions] CE is a safe and effective modality for the patients with severe OGIB by providing positive findings in the majority of patients.Of all the small intestinal lesions,vascular lesion was most common,followed by small bowel tumor.