胶囊内镜检查对小肠疾病的诊断价值及不同胶囊内镜系统的比较

Diagnostic value of capsule endoscopy examination for small intestinal diseases and comparison of different endoscopy examination systems

目的:探讨胶囊内镜(CE)检查系统对小肠疾病的诊断价值及不同CE检查系统的优劣。方法:收集2010年3月—2015年12月因消化系统症状于湘雅二医院就诊并行CE检查的患者417例临床资料。比较进口CE检查系统与国产CE检查系统间体内工作时间、胃及小肠运行时间、检查完成率、诊断阳性率、病变检出率及胶囊滞留率,并分析不同年龄段与不同检查原因的小肠疾病诊断构成情况。结果:进口CE组与国产CE组比较,体内工作时间、胃转运时间、胃及小肠转运时间延长,检查完成率升高(88.8%vs.84.0%)(均P<0.05),诊断阳性率(76.6%vs.70.5%)、病变检出率(89.8%vs.90.1%)及胶囊滞留率(0.5%vs.1.0%)两组间无统计学差异(均P>0.05);CE在不同年龄段患者中均以血管性病变检出最多,在未成年组(<18岁以内)、中青年组(18～59岁)以及老年组(≥60岁)分别为44.5%、22.7%及34.3%,其次在未成年组为非特异性炎症(22.2%),在中青年组为克罗恩病(17.6%),在老年组为肿瘤(22.9%)。不明原因消化道出血患者检出病变主要为血管性病变(43.0%)、肿瘤(14.8%)、非甾体消炎药相关性胃肠黏膜病(6.3%)、克罗恩病(6.3%)、憩室(7.0%)、急性胃黏膜病变(3.1%)、非特异性炎症(7.0%);不明原因腹痛患者检出的疾病主要为功能性胃肠病(27.5%)、克罗恩病(19.6%)、非特异性炎症(15.7%)、肠结核(9.8%)、肿瘤(9.8%)、肠易激综合征(7.8%)、血管性病变(2.0%)。结论:CE检查对小肠疾病有较高的病变检出率,且适用人群广、安全性高。进口CE检查系统与国产CE检查系统的诊断价值相似。

Objective： To investigate the diagnostic value of capsule endoscopy （CE） examination for small intestinal diseases and compare the merits and drawbacks of different CE examination systems. Methods： Four hundred and seventeen patients undergoing CE examination for gastrointestinal symptoms in the Second Xiangya Hospital of Central South University from March 2010 to December 2015 were enrolled. The working time, transit times in the stomach and small bowel, examination completion rate, positive diagnostic rate, lesion detection rate and capsule retention rate were compared between domestic and foreign imported CE examination systems, and the constitutions of the diagnosed small bowel diseases in patients of different ages and undergoing examination for different reasons were also analyzed. Results： In foreign imported CE group compared with domestic CE group, the working time, and transit times in the stomach and small bowel were prolonged, and the examination completion rate was increased （88.8% vs. 84.0%） （all P〈0.05）, but the positive detection rates （76.6% vs. 70.5%）, lesion detection rates （89.8% vs. 90.1%） and capsule retention rate （0.5% vs. 1.0%） showed no significant differences （all P〉0.05）. Vascular diseases were the most frequently detected by CE in patients of each age group, which in underage group （ age 〈18 years）, young and middle-aged group （ age 18- 59 years） and elderly group （ age ≥ 60 years ） were 44.5%, 22.7% and 34.3%, and in the second place were nonspecific inflammation （22.2%） in underage group, Crohn＇s disease （17.6%） in young and middle-aged group and tumors （22.9%） in elderly group, respectively. The detected diseases in patients for obscure gastrointestinal bleeding mainly included vascular diseases （43.0%）, tumors （14.8%）, nonsteroidal anti-inflammatory drug-associated gastrointestinal mucosal disease （6.3%）, Crohn＇s disease （6.3%）, diverticulum （7.0%）, acute gastric mucosal lesion （3.1%）, and nonspecific inflammation （7.0%）, and in patients for unexplained abdominal pain mainly included functional gastrointestinal disorders （27.5%）, Crohn＇s disease （19.6%）, nonspecific inflammation （15.7%）, intestinal tuberculosis （9.8%）, tumors （9.8%）, irritable bowel syndrome （7.8%） and vascular diseases （2.0%）. Conclusion： CE examination has higher detection rates for small bowel diseases, with applicability to wide population groups and high safety. The domestic and foreign imported CE examination systems have similar diagnostic value.