双气囊小肠镜、CT小肠造影及两者联合在小肠疾病诊断中的应用

Application of double-balloon enteroscopy,CT enterography and their combination to diagnosis of small intestinal diseases

目的探讨双气囊小肠镜(DBE)、CT小肠造影(CTE)及两者联合在小肠疾病诊断中的应用效果。方法纳入不明病因的小肠疾病患者145例,其中临床表现为消化道出血24例,慢性腹痛80例,腹胀15例,腹泻16例,怀疑克罗恩病10例,均行CTE及DBE检查,分析CTE、DBE及两者联合检查对病因的检出情况。结果 DBE以及联合检查对消化道出血病因的总检出率及血管畸形的检出率均高于CTE,对腹痛病因的总检出率及小肠非特异性炎症的检出率均高于CTE,对腹泻病因的总检出率及原发性小肠吸收不良的检出率均高于CTE(均P <0. 05)。对于腹胀的病因以及疑似克罗恩病,CTE、DBE、联合检查的总检出率差异均无统计学意义(均P> 0. 05)。结论 DBE和联合检查在诊断血管畸形方面优于CTE,而对于占位性病变和可疑克罗恩病的诊断,DBE、CTE以及联合检查诊断价值相当,但是联合检查的互补作用可提供更多的疾病信息。

Objective To investigate the effect of double-balloon enteroscopy(DBE),CT enterography(CTE)and their combination applied to diagnosing small intestinal diseases.Methods A total of145patients with small intestinal diseases of unknown etiology were enrolled,including24cases with gastrointestinal bleeding,80cases with chronic abdominal pain,15cases with abdominal distention,16cases with diarrhea and10cases suspected as Crohn's disease.CTE and DBE were performed in all cases.The detection rates of CTE,DBE and combined examination for etiology were analyzed.Results DBE or combined examination had higher total detection rates for the etiology of gastrointestinal bleeding and higher detection rate for vascular malformation compared to CTE,so did the total detection rates for the etiology of abdominal pain and higher detection rate for nonspecific inflammation of the small intestine,and DBE or combined examination obtained higher total detection rate for the etiology of diarrhea and higher detection rate for primary small intestinal malabsorption compared to CTE(all P﹤0.05).For the etiology of abdominal distention and cases suspected as Crohn's disease,there was no statistically significant difference in the total detection rate among CTE,DBE and combined examination(all P﹤0.05).Conclusion DBE and combined examination are superior to CTE in the diagnosis of vascular malformation.For space-occupying lesion and suspected/confirmed Crohn's disease,DBE,CTE and combined examination have the similar diagnostic value,but the complementation of combined examination can provide more information about the diseases.