胶囊内镜在放射性小肠炎诊断中的临床价值分析

Clinical value analysis of capsule endoscopy in diagnosis of radiation enteritis

目的探讨胶囊内镜下放射性小肠炎的典型表现及其在临床诊断中的应用价值。方法回顾性分析2019年1月至2021年9月于西安交通大学第二附属医院就诊的盆、腹腔肿瘤放射治疗后行胶囊内镜检查发现并经双气囊小肠镜检查及病理证实的9例放射性小肠炎患者资料。结果9例患者(1男/8女,包括宫颈癌6例、子宫内膜癌2例、直肠癌1例),平均发病年龄(66.0±4.5岁),放疗照射总剂量为46~85 Gy,临床症状主要表现为腹痛、便血、部分伴腹胀、腹泻。9例患者检查前均经影像学排除肠管狭窄或肠梗阻,其中3例检查结束时胶囊未进入结肠,5例存在小肠多发溃疡,伴管腔狭窄者3例,1例出现胶囊滞留至回肠中下段。所有患者均进行双气囊小肠镜检查(经肛8例,经口1例),内镜下表现与胶囊内镜相符合,病变处活检取材证实为炎性水肿。结论胶囊内镜作为一种无创、便捷的检查方式可以作为放射性小肠炎的一线检查手段,但是应充分评估患者小肠狭窄存在的可能性以避免胶囊滞留不良事件的发生。

Objective To investigate the typical manifestations of radiation enteritis under capsule endoscopy and its application value in clinical diagnosis.Methods The data of 9 patients with radiation enteritis found by capsule endoscopy and confirmed by enteroscopy and pathology after radiotherapy of pelvic and abdominal tumors in our hospital from January 2019 to September 2021 were analyzed retrospectively.Results There were 9 patients(1 male/8 female,including 6 cases of cervical cancer,2 cases of endometrial cancer and 1 case of rectal cancer).The average age of onset was 66.0±4.5 years old.The total dose of radiotherapy was 46-85gy.The clinical symptoms were abdominal pain,melena,some with abdominal distension and diarrhea.Before examination,9 patients were excluded from intestinal stenosis or intestinal obstruction by imaging examination;Among them,3 cases did not enter the colon at the end of the examination,5 cases had multiple ulcers of the small intestine,3 cases had lumen stenosis,and 1 case had capsule retention in the middle and lower ileum.All patients underwent double balloon enteroscopy(8 cases through anus and 1 case through mouth).The endoscopic findings were consistent with capsule endoscopy,and the biopsy materials at the lesion were confirmed to be inflammatory edema.Conclusion As a non-invasive and convenient examination method,capsule endoscopy can be used as the first-line examination method of radiation enteritis,but the possibility of small intestinal stenosis should be fully evaluated to avoid the occurrence of adverse events of capsule retention.