胶囊内镜在小肠疾病诊断中的临床应用体会

The Experience of Using Capsule Endoscopy in Diagnosis of Small Bowel Diseases

目的:评价胶囊内镜在小肠疾病诊断过程中的诊断价值、安全性、耐受性。方法:自2011年5月至今,笔者所在科应用OMOM胶囊内镜对胃镜肠镜检查阴性的疑似小肠病变患者进行胶囊内镜检查,其中包括不明原因的消化道出血16例。结果:发现病灶者20例,所见病变其中包括小肠血管畸形11例,小肠多发息肉(Peutz-Jeghers综合征)1例,炎症性肠病/克罗恩病3例,NASID相关溃疡1例,小肠局灶隆起2例,小肠绒毛萎缩2例;未见异常7例;未成功2例。胶囊停留于胃内的平均时间为65 min(11 s^420 min),小肠内平均运行时间为312 min(171~453 min),平均到达盲肠时间为371 min(210~476 min),平均记录时间为446 min(390~620 min),医师对胶囊内镜所传输图像的平均读片时间为96 min(60~120 min),平均获取照片数为58 193张,胶囊平均排出体外时间为46 h(24~120 h)。所获取的图像质量良好。整个操作过程患者耐受性甚佳,无任何痛苦,吞咽胶囊无任何困难,检测过程中无任何严重并发症发生。结论:胶囊内镜虽然存在无法取病理等一定的不足之处,但因其高效安全、无痛苦,在小肠疾病尤其是不明原因消化道出血疾病诊断中仍有独特的优势。

Objective：To evaluate the diagnostic value,security and patients’ tolerance of capsule endoscopy in the diagnosis of small bowel disease process.Method：From may 2010 to now,gastroendoscopy and colonoscopy examination negative patients who were suspected with small bowel diseases accept capsule endoscopy examination,in them 16 patients with obscure gastrointestinal bleeding.Result：20 patients were positive with lesions,including 11 with intestinal vascular malformation,1 with Peutz-Jeghers syndrome,3 with Crohn’s disease,1 with NASID related ulcers,2 with intestinal local uplift lesions, 2 with small intestinal villus atrophy.7 patients were negative.2 patients were not successful to complete examination.The average time of capsule kept staying in stomach was 65 min（11 s-420 min）.The average time capsule went through the small intestine was 312 min（171-453 min）,the average time capsule reached the cecum was 371 min（210-476 min）,the average whole time was 446 min（390-620 min）,the average time doctor reading medical image was 96 min（60-120 min）, the mean photos number was 58 193,the average time capsule excreted out was 46 h（24-120 h）.The good image quality was obtained.In the whole process,the tolerance of patients was good,no pain,swallowing capsules without any difficulty,no serious complication occurred during examination.Conclusion：Authough capsule endoscopy has some shortcomings such as pathological tissues can not be got,because of its high safety,no pain,it still has its unique advantages in diagnosis of small intestinal diseases,especially in obscure gastrointestinal bleeding.