双气囊小肠镜治疗胶囊内镜滞留的临床研究

A clinical study on retrieval of retained capsules by double balloon enteroscopy

目的评价经双气囊小肠镜取出滞留胶囊内镜的有效性及安全性，并探讨影响其取出成功率的相关因素。方法对2010年1月至2013年12月就诊的23例胶囊内镜滞留，并经双气囊小肠镜行胶囊内镜取出术的患者进行回顾性分析，根据其是否取出分为成功组和未成功组，比较2组进镜方式、进镜深度及病变部位等方面的差异。结果23例患者中，15例成功取出，成功率65．2％。2组滞留时间差异无统计学意义[20．0（15．0，57．0）d比21．0（16．0，240．0）d，P：0．525]。经口进镜的成功率明显大于经肛进镜[71．4％（15／21）比0／5，P=0．007]。胶囊内镜滞留于空肠及以上经口进镜取出成功率明显大于回肠（8／8比7／13，P=0．046），且成功取出患者的进镜深度明显小于未取出患者[（167．3±33．8）cm比（258．3±23．9）cm，P=0．041]。术前x线，显示胶囊是否位于盆腔与经口进镜取出成功率（9／14比5／6，P=0．613）及进镜深度[（132．0±68．6）cm比（200．0±40．3）em，P=0．376]无关，且无法预测胶囊的实际位置。结论经口双气囊小肠镜是取出滞留胶囊内镜的有效方式，成功率与滞留时间长短无关。胶囊内镜滞留于十二指肠及空肠较回肠更容易取出。

Objective To evaluate the effectiveness and safety of double balloon enteroscopy（DBE） in retrieval of retained capsule and identify the factors associated with successful retrieval. Methods A total of 23 consecutive retention cases who received retrieval of retained capsules by DBE from January 2010 to December 2013 were reviewed. They were assigned to success group and failure group. The differences in insertion route, insertion depth, lesion location between the two groups were analyzed. Results Fifteen cases of all 23 retention cases were successfully retrieved and the success rate was 65.2%. There was no significant difference in the mean entrapped period of CE between the two groups [ 20. 0（15. 0,57. 0） d VS 21.0（ 16.0,240. 0）d, P= 0. 525 ]. DBE via oral route exhibited remarkable higher success rate than anal route [ 71.4% （15/21） VS 0/5, P= 0. 007]. Compared with ileum, it was easier to take out CE located at jejunum（ 8/8 VS 7/13, P = 0. 046 ） and the insertion depth was significantly less in the success group [ （ 167.3±33.8）cm VS （258.3±23.9） cm, P=0. 041]. Whether the capsule was in pelvic cavity shown by x-ray film before the surgery was irrelevant to the successful rate （9/14 VS 5/6, P = 0. 613 ）and insertion depth of the DBE on access to the capsule[ （ 132. 0±68. 6） em VS （200. 0±40. 3） cm, P=0. 376] ,or to the actual location of the capsule. Conclusion Peroral DBE is an effective method for removal of retained CE and the success rate isn＇t relevant to the entrapped period. Retained CE locates in ileum and jejunum is more difficult to be taken out than in duodenum.