摘要
目的探讨小肠溃疡性病变的临床、内镜、病理等特点。方法临床怀疑小肠疾病者155例。按术者操作内镜并送镜,助手辅助进外套管的方法。结果 155例患者中,125例发现病变,阳性率80.6%。检出的主要疾病为小肠溃疡(含克罗恩病)、慢性炎症、美克尔憩室、间质瘤、血管畸形、小肠癌等。其中92例怀疑小肠出血者,检查阳性84例(91.3%);39例腹痛患者中,阳性24例(61.5%);腹泻、腹胀、消瘦23例,阳性16例(69.6%)。病变位于胃及十二指肠9例,小肠病变115例,大肠病变1例,全消化道未发现病变30例。在155例接受双气囊内镜(DBE)检查的患者中,检出小肠溃疡性病变43例;病灶数为单个12例,多个(2个及以上)31例;病变位于空肠的18例,回肠20例,空肠和回肠都有病变的5例。DBE 结合组织学检查对美克尔憩室、间质瘤、癌、血管病变、肠黏连的诊断与手术后诊断是完全相符的;而对溃疡性病变(主要是克罗恩病)的诊断与手术后诊断却相差较大,符合率57.1%(4/7)。发生小肠穿孔和急性肠梗阻并发症各1例。结论 DBE 目前是诊断小肠疾病安全、有效的方法,特别在发现病变方面,但对溃疡性病变的定性即使结合活检也未必是特异的,及时行外科处理对某些溃疡性病变的诊断和治疗都是有益的。
Objective To study the diagnostic value of double-balloon endoscopy （DBE）for small intestinal diseases. Methods 155 patients clinically suspicious of small intestinal diseases were studied. 110 of them were male and 45 female. Their age ranged from 6 to 75 and with an average of 41 years. They consisted of 92 cases of small intestinal hemorrhage, 39 abdominal pain, 7 diarrhoea, 13 abdominal distention, 3 malnutrition and one diarrhoea as well as refractory hypoalbuminemia. In the procedure, the operator manipulated and advanced the endoscope and the assistant helped to advance the over tube. Results Among the 155 cases lesions were found in 125 cases, with positive results accounting for 80.6%. These lesions mainly consisted of small intestinal ulcer（including Crohn＇s desease）, chronic inflammation, Meckel＇s diverticulum, interstitialoma,vascular deformity and carcinoma of small intestine. In 84 of the 92 patients suspicous of intestinal hemorrhage the lesions were confirmed with a positive rate of 91.3%. In 24 of the 39 patients with abdomen pain the etiologies were confirmed with a positive rate of 61.5%. In 16 of the 23 patients with diarrhoea, abdominal distention and malnutrition the positive rate was 69. 6%. The cause of the only one case with refractory hypoalbuminemia was confirmed. Among the 155 cases, 9 had lesions located in stomach and duodenum, 115 in small intestine and one in large bowel, no lesion was found in 30 cases. Among the patients, 43 were found to have small intestinal ulcer. In the 43 patients, 12 patients were with single intestinal ulcer and 31 with multiple. For cases of Meckel＇s diverticulum, interstitialoma, carcinoma, vascular deformity and intestinal adhesion of small intestine in this series, diagnoses made by DBE combined with morphology were completely consistent with those found in operation. However, for ulcer lesions （mainly Crohn＇s disease）, there was diversity in the diagnoses between the two methods, the coincidence was 57.1%. Two patients had complica
出处
《中华内科杂志》
CAS
CSCD
北大核心
2007年第5期383-385,共3页
Chinese Journal of Internal Medicine
基金
广东省自然科学基金(5004770)
关键词
小肠
诊断
双气囊内镜
Intestine, small
Diagnoses
Double balloon endoscopy
