54例原发性小肠淋巴管扩张症胶囊内镜下特点分析

Characteristics of 54 cases of primary intestinal lymphangiectasia in capsule endoscopy

目的探讨原发性小肠淋巴管扩张症(primary intestinal lymphangiectasia,PIL)胶囊内镜(capsule endoscopy,CE)下的特点。方法收集2011年3月至2016年7月于我院消化内科行CE检查的PIL患者的临床及内镜资料。总结其内镜特点,并提出一种分类方法,初步评价该分类的临床意义。结果共54例PIL患者纳入回顾性分析。内镜下分型标准如下:Ⅰ型:具有淋巴管扩张的典型表现,如黄白色斑块或斑点,全小肠广泛受累;Ⅱ型:具有淋巴管扩张的典型表现,病变分布较局限,常累及小肠三个肠段中的1~2段;Ⅲ型:内镜下为不典型表现,仅详细观察时可见到大致正常,但呈现水肿、扁平的绒毛。分别有13例(24.1%)、24例(44.4%)及17例(31.5%)归类为Ⅰ型、Ⅱ型与Ⅲ型。Ⅰ型患者的平均年龄明显低于Ⅱ型。Ⅱ型患者CE下检出肠腔内淋巴漏及出血的比例最低。结论小肠淋巴管扩张症(intestinal lymphagiectasia,IL)在CE下不一定出现典型表现。CE下的IL分型可能代表了IL的不同亚型,值得进一步研究。

Objective To investigate the characteristics of primary intestinal lymphangiectasia(PIL)in capsule endoscopy(CE).Methods Aretrospective study was performed to collect the endoscopic characteristics of patients who underwent CE and were diagnosed as PIL in the Department of Gastroenterology,Beijing Shijitan Hospital,Capital Medical University,from Mar.2011 to Jul.2016.A novel endoscopic classification of PIL in CE was developed and the clinical correlation was investigated.Results A total of 54 patients with PIL were included in this retrospective analysis.The endoscopic classification was established as follows:type I,typical findings of lymphangiectasia,namely white plaques,spots or pinhead size spots,diffusely located in almost the whole small bowel;typeⅡ,typical findings of lymphangiectasia,mostly scattered in one or two of all three third small bowel segments;typeⅢ,untypical findings were detected and the abnormalities were mostly restricted to apparently normal but low or edematous villi under detailed inspection.13 cases(24.1%),24 cases(44.4%)and 17 cases(31.5%)of PIL were classified into typeⅠ,typeⅡand typeⅢ,respectively.The mean age of patients in typeⅠgroup was significantly lower than the patients in typeⅡgroup.The percentage of leakage of lymphatic fluid and bleeding into bowel lumen detected in CE was lowest in typeⅡgroup.Conclusion Intestinal lymphangiectasia(IL)may have untypical endoscopic findings in addition to classical findings in CE.The endoscopic classification of IL in CE may have potential to classify the IL into various subtypes.