气囊辅助小肠镜治疗Peutz-Jeghers综合征的临床价值

Clinical value of balloon assisted enteroscopy for patients with Peutz-Jeghers syndrome

目的探讨气囊辅助小肠镜治疗Peutz-Jeghers综合征(Peutz-Jeghers syndrome,PJS)患者小肠息肉的临床价值与安全性。方法回顾性分析2006年6月-2014年3月在北京军区总医院就诊并行气囊辅助小肠镜下息肉切除术的28例PJS住院患者的临床资料。结果 28例患者共行气囊辅助小肠镜下息肉切除术44例次,其中经口进镜28例次,经肛进镜16例次。1例小肠息肉呈密切分布,给予腹腔镜联合小肠镜切除息肉。17例患者小肠镜前行术前检查,其中6例行小肠钡餐造影检查,11例行小肠仿真CT检查。术前检查组单次切除息肉数高于未检查组。术后出现并发症3例次(消化道出血1例次,术中穿孔2例次),并发症发生率6.8%。结论气囊辅助小肠镜下切除小肠息肉治疗PJS安全有效。术前检查有助于小肠镜进镜方式的选择。对于息肉密集分布患者,单纯镜下切除困难,可内镜联合腹腔镜治疗,一次大量切除小肠息肉,达到较好的治疗效果。

Objective To investigate the clinical value and safety of balloon assisted enteroscopy （BAE） for patients with Peutz-Jeghers syndrome （PJS）. Methods Clinical data of 28 patients with PJS treated by BAE in Beijing Military General Hospital from Jun. 2006 to Mar. 2014 were analyzed retrospectively. Results Forty-four BAE procedures （28 of oral approach, 16 of anal approach） were carried out in 28 patients. Small intestinal barium meal examination or sim- ulation of CT examination of small intestine were scheduled before BAE in 17 patients and not scheduled in 11 patients. The number of single polyps resection in examination group were higher than that in without examination group. A total of three complications occurred （bleeding in one case and perforation in two cases after endoscopic resection）. The com- plication rate was 6.8%. Conclusion BAE is a safe and reliable procedure for the treatment of small bowel polyps in patients with PJS. Small intestinal barium meal examination or simulation of CT examination of small intestine are help for choice of oral or anal approach. Endoscopy combined with laparoscope can be used in patients with large number and crowded polyps.