胶囊内镜联合小肠CT造影在小肠疾病中的诊断价值

Diagnostic value of capsule endoscopy combined with computed tomography enterography for small intestinal diseases

目的:评估胶囊内镜(capsule endoscopy,CE)联合小肠CT造影(computed tomography enterography,CTE)对小肠疾病的诊断价值.方法:回顾分析114例疑似小肠疾病的患者,在间隔2-7 d内先后行CE及小肠CTE检查,参照最终诊断结果(病理诊断或后续随访结果),比较这两种检查方法发现小肠疾病的阳性率,以及二者联合对小肠疾病诊断准确性的影响.结果:114例患者中,不明原因消化道出血35例,不明原因腹痛(伴或不伴大便习惯改变)32例,疑诊克罗恩病29例,不明原因消瘦18例.C E和C T E对不明原因消化道出血的诊断阳性率分别为51.4%和40.0%,二者相比有统计学意义(P<0.05),二者联合诊断阳性率为57.1%.CE和CTE对不明原因腹痛患者的病变检出率差异不大(46.9%vs 40.6%,P>0.05),二者联合诊断的阳性率为59.3%,较单独CE和CTE诊断率更高(P<0.05).对疑诊克罗恩病患者,CE能更多地发现小肠病变,诊断阳性率高于CTE(86.2%vs 65.5%,P<0.05),联合二者检查,诊断阳性率提高到93.1%,与CTE相较有显著差异.结论:CE和CTE对疑似小肠疾病患者都有较好的诊断价值,但CE对不明原因消化道出血、疑似克罗恩病的诊断价值高于CTE,二者联合意义更大.

AIM：To assess diagnostic value of capsule endoscopy（CE） combined with computed tomography enterography（CTE） for small bowel diseases.METHODS：One hundred and fourteen patients with suspected small bowel diseases underwent CE and CTE examinations（interval time 2-7 d）.The diagnostic accuracy for small bowel diseases was compared between CE and CTE,based on pathological or follow-up results.The diagnostic accuracy of combined CE and CTE was also estimated.RESULTS：The symptoms of enrolled patients included obscure gastrointestinal bleeding（OGIB,35 cases）,unexplained abdominal pain（32 cases）,suspected Crohn＇s disease（29 cases）and unexplained weight loss（18 cases）.For OGIB,CE had a higher diagnostic accuracy than CTE（51.4%vs 40.0%,P〈0.05）.The diagnostic accuracy reached 57.1%when the two methods were combined.For unexplained abdominal pain,diagnostic accuracy was comparable between CE and CTE（46.9%vs 40.6%,P〉0.05）.The diagnostic accuracy reached 59.3%when the two methods were combined,which was higher than that of CE or CTE alone.For suspected Crohn＇s disease,CE had a higher diagnostic accuracy than CTE（86.2%vs 65.5%,P〈0.05）.The diagnostic accuracy reached 93.1%when the two methods were combined,which was higher than that of CTE alone.CONCLUSION：Both CE and CTE prove to be effective procedures for patients with suspected small bowel disease,but the diagnostic value of CE is higher than that of CTE for OGIB and suspected Crohn＇s disease.The combination of CE and CTE may be a better strategy.