573例胶囊内镜检查回顾性分析

A Retrospective Analysis of Capsule Endoscopy in 573 Cases

背景:大量国内文献报道胶囊内镜对小肠疾病具有较高的诊断价值,但大样本研究相对少见。目的:分析胶囊内镜检查对小肠疾病的诊断价值和安全性。方法:回顾性连续性纳入2008年5月—2013年4月因拟诊小肠疾病在南京军区南京总医院行胶囊内镜检查的患者,对检查结果进行统计学分析。结果:共573例患者纳入研究,总体检查成功率为99.13%(568/573),全小肠检查完成率为88.38%(502/568);胶囊内镜通过幽门时间平均为43.45 min,通过小肠时间平均为287.21 min。总体小肠病变检出率和诊断率分别为53.52%(304/568)和51.06%(290/568);不明原因消化道出血(OGIB)患者的病变检出率和诊断率均显著高于不明原因腹痛和慢性腹泻患者(64.26%和62.46%对41.72%和39.07%、32.14%和27.38%,P均<0.05)。检出的小肠病变主要包括血管病变(21.38%)、溃疡性病变(20.72%)、肿瘤(14.47%)、糜烂性病变(11.84%)、克罗恩病(11.18%)。胶囊内镜滞留率为2.29%(13/568),分别有1例和2例滞留者并发急性肠梗阻和肠穿孔。结论:对于小肠疾病,胶囊内镜是一种安全、有效的检查方法,其最重要的适应证是OGIB,对确诊或疑诊克罗恩病患者的评估亦有一定帮助。

Background： Capsule endoscopy has been demonstrated to be an effective diagnostic tool for small bowel diseases in a series of small sample researches. However,the results need to be verified by large sample studies. Aims： To investigate the diagnostic performance and safety of capsule endoscopy for small bowel diseases. Methods： Consecutive patients undergoing capsule endoscopy for suspected small bowel diseases from May 2008 to Apr. 2013 in Nanjing General Hospital of Nanjing Military Command of PLA were collected and analyzed retrospectively. Results： A total of 573 patients were enrolled,the overall success rate of the examination was 99. 13%（ 568 /573） and the overall completion rate was 88. 38%（ 502 /568）. The mean time of capsule passing the pylorus was 43. 45 min,and that of passing the small bowel was287. 21 min. The overall detection rate of small bowel lesions was 53. 52%（ 304 /568） and the overall diagnostic rate was51. 06%（ 290 /568）. Both the detection rate and diagnostic rate in patients with obscure gastrointestinal bleeding（ OGIB）were significantly higher than those in patients with obscure abdominal pain and chronic diarrhea（ 64. 26% and 62. 46%vs. 41. 72% and 39. 07%,and 32. 14% and 27. 38%,P all 0. 05）. Small bowel lesions detected by capsule endoscopy included angiopathy（ 21. 38%）,ulceration（ 20. 72%）,neoplasms（ 14. 47%）,erosion（ 11. 84%）,and Crohn ＇s disease（ 11. 18%）,etc. Capsule retention occurred in 2. 29%（ 13 /568） of the patients,and one acute intestinal obstruction and 2 perforations were observed. Conclusions： Capsule endoscopy is a safe and effective diagnostic modality for small bowel diseases. OGIB is the most common indication for capsule endoscopy,and capsule endoscopy is also helpful for evaluation of established or suspected Crohn＇s disease.