胶囊内镜检查在145例患儿中的临床应用

Clinical analysis of 145 cases of pediatric capsule endoscopy

目的回顾2012年12月—2016年7月在复旦大学附属儿科医院行胶囊内镜检查的145例患儿的临床资料,评价胶囊内镜检查在儿童中的应用和临床价值。方法回顾性分析145例行胶囊内镜检查患儿的一般资料和临床资料,根据胶囊内镜工作记录,分别统计无法吞服胶囊内镜需胃镜辅助置入、自行吞入但仍需胃镜辅助置入十二指肠和完全不需要胃镜完成胶囊内镜检查的患儿数,胶囊内镜的总工作时间、胃通过时间、小肠通过时间,小肠病变检出情况,观察胶囊内镜检查的安全性,同时分析炎症性肠病(IBD)患儿中胶囊内镜和其他检查的病变检出情况。结果 145例中,男91例、女54例,平均年龄为(10.6±0.3)岁。无法吞服需胃镜辅助下送入胶囊内镜者22例(15.2%),平均年龄为(8.3±0.8)岁;可自主吞服胶囊内镜者123例(84.8%),平均年龄为(11.0±0.3)岁。无法吞服胶囊内镜患儿的年龄显著小于可自主吞服胶囊内镜的患儿(P<0.000 1)。在可自主吞服胶囊内镜的123例患儿中,自主吞服胶囊内镜但需胃镜辅助下置入十二指肠者64例(44.1%),平均年龄为(10.6±0.4)岁;完全不需要胃镜完成胶囊内镜检查者59例(40.7%),平均年龄为(11.5±0.3)岁。可自主吞服胶囊内镜的患儿中是否需要胃镜辅助的患儿间年龄的差异无统计学意义(P>0.05)。胶囊内镜平均总工作时间为(616.6±7.4)min,平均胃通过时间为(46.7±6.2)min,平均小肠通过时间为(291.9±10.6)min。Pearson相关性分析显示,年龄与胃通过时间、小肠通过时间均无相关性(P值均>0.05)。小肠病变检出率为73.1%(106/145),病变类型主要为小肠溃疡。51例IBD患儿中,新发IBD患儿36例,其胶囊内镜检查、结肠镜检查、上下腹部增强CT检查和小肠增强MRI检查的小肠病变阳性发现率分别为100.0%(36/36)、91.7%(33/36)、78.1%(25/32)和86.4%(19/22);IBD复诊患儿15例,其胶囊内镜检查、结肠镜检查、上下腹部增强CT检查和小肠增强MRI检查的小肠病变阳性发现率分别为14/15、11/13、4/5和3/4。完成胶囊内镜检查的患儿均在2周内自主排出胶囊,未发现胶囊内镜滞留现象。结论胶囊内镜检查是一种无创、安全、有效的小肠检查手段,在儿童IBD的诊断和复发监测中有较好的应用价值,在某些小肠疾病的诊断中也发挥着其他检查不能替代的作用,可以在儿科消化领域中推广应用。

Objective To retrospectively analyze the clinical deta of 145 child patients undergoing capsule endoscopy between December 2012 and July 2016 in the Children＇s Hospital of Fudan University, and to evaluate the clinical value of pediatric capsule endoscopy. Methods A total of 145 children undergoing capsule endoscopy were enrolled in this retrospective study. The numbers of the patients who could swallow autonomously the capsule, who could not swallow the capsule and who needed gastroscopic assisted capsule endoscopy were recorded. The total operation time of capsule endoscopy, gastric transit time, small intestine transit time and the rate of positive finding were also recorded, especially in the patients with inflammatory bowel disease （IBD）. Results There were 91 males and 54 females with an average age of（10.6± 0.3） years old. The capsule could be swallowed autonomously in 123 children （84.8%）, and could not completely in 22 children （15.2%）. The former was significantly elder than the later （[11.0±0.3] years old vs. [8.3 ± 0.8] years old, P〈0. 000 1）. In the 123 children, capsule stayed in the stomach for more than 2.5 hours in 64 patients （44. 1%, [10.6±0.4] years old）, and then was taken into the duodenum with endoscopic guidence; capsule endoscopy was completely performed without the gastroscope assisted procedure in 59 patients （40.7%, [11.5 ± 0.33 years old）. There was no significant difference in the age between them （ P;0. 051. The total operation time of capsule endoscopy was （616.6 ± 7.41 rain. The mean gastric transit time was （46.7±6.2） min. The mean small intestine transit time was （291.9±10.61 min. Pearson analysis showed that patient＇s age was not correlated with the gastric transit time or small intestine transit time of the capsule （both P 〉 0. 05）. The rate of positive findings on capsule endoscopy was 73.1% （106/145）, mainly presenting small intestinal ulcer. There were 51 IBD patients, in the 36 newly diagnosed IBD patients, the rates of positive findings on capsule endoscopy, colonoscopy, abdominal enhancedOT and MRI were 100. 0% （36/36）, 91. 7% （33/361, 78. 1% （25/321 and 86. 4% （19/22）, respectively. In the 15 patients with a history of IBD, the rates of positive findings on capsule endoscopy, colonoscopy, abdominal enhanced CT and MRI were 14/15, 11/13, 4/5 and 3/4, respectively. The capsule was expelled naturally in all the patients within 2 weeks. Conclusion Capsule endoscopy is an effective, safe and noninvasive tool for the diagnosis and recurrence monitoring of small bowel diseases, in children with IBD, the rate of positive findings on capsule endoscopy is higher than abdominal enhanced CT and small bowel MRI.