小肠重度狭窄的预测因素分析

Predictors for severe stenosis in small bowel

目的 严重的小肠狭窄可不出现易于识别的肠梗阻,易导致胶囊内镜检查中胶囊滞留。本研究拟探讨小肠重度 狭窄的预测因素,帮助降低胶囊内镜检查的滞留风险。方法 回顾空军特色医学中心2012年9月1日 2018年10月31日完成 的诊断性气囊辅助小肠镜(balloon-assisted enteroscopy,BAE)住院患者,有59例。根据BAE检查中所见将小肠狭窄分为 重度狭窄(小肠镜镜身不可通过)和非重度狭窄(小肠镜可见明显狭窄且镜身可顺利通过)2组。分析小肠重度狭窄与性别、 年龄、症状性梗阻、消化道出血、腹部CT/MRI提示狭窄、病因诊断、开腹手术史、体型等的相关性,并通过分析明确小肠重 度狭窄的独立预测因素。结果 纳入的59例BAE小肠狭窄的患者中36例为重度狭窄者、23例为非重度狭窄者。消化道出血 (P= 0.015)、高血压病史(P=0.024)及腹部CT/MRI提示狭窄(P=0.040)与小肠重度狭窄具有显著相关性;症状性梗阻、年 龄>60岁、男性、狭窄病因、体型和开腹手术史等与小肠重度狭窄无显著相关性(P>0.05)。多因素分析显示显性消化道出血 是小肠重度狭窄的独立保护因素(P=0.022)。结论 显性消化道出血是小肠重度狭窄的独立保护因素。腹部CT/MRI提示小 肠狭窄或梗阻与小肠重度狭窄具有显著相关性;无小肠症状性梗阻不足以除外小肠重度狭窄,对无梗阻症状患者行胶囊内镜 检查有风险。

Objective To analyze the predictors of severe small intestinal stenosis that does not always present an easily identifiable intestinal obstruction.Methods We retrospectively reviewed the clinical data of 59 patients treated with diagnostic balloon-assisted enteroscopy(BAE)in our center between September 1,2012 and October 31,2018.According to the results of BAE examination,these cases of intestinal stenosis were divided into two groups:severe stenosis and non-severe stenosis groups.Chi-square test was used to analyze the correlations between severe small intestinal stenosis and gender,age,symptomatic obstruction,overt gastrointestinal bleeding,abdominal CT/MRI indicating stenosis,etiology of stenosis,and history of laparotomy.Multivariate analysis was performed to identify independent predictors of severe intestinal stenosis.Results Among the 59 patients with small intestinal stenosis,36 had severe stenosis and 23 had non-severe stenosis.Overt gastrointestinal bleeding(P=0.015),history of hypertension(P=0.024)and abdominal CT/MRI indicating stenosis(P=0.040)were significantly correlated with severe small intestinal stenosis.There was no significant correlation between symptomatic obstruction,age>60 years old,male,cause of stenosis,body type and history of laparotomy and severe small bowel stenosis(P>0.05).Multivariate analysis showed that overt gastrointestinal bleeding was an independent predictor for severe intestinal stenosis(P=0.022).Conclusion Overt gastrointestinal bleeding is an independent protective factor for severe small intestinal stenosis,and abdominal CT/MRI indicating stenosis has a significant correlation with severe intestinal stenosis.Symptomatic obstruction cannot be used as an independent predictor of severe intestinal stenosis,and capsule e ndoscopy is r isky for p atients w ithout s ymptomatic o bstruction.