摘要
目的回顾性分析小肠疾病的临床表现和组成类型,探讨针对小肠疾病如何有效合理应用胶囊内镜(VCE)、双气囊小肠镜(DBE)、计算机断层扫描肠成像(CTE)检查,以提高小肠疾病的诊断率。方法2015年1月至2022年6月在四川省医学科学院•四川省人民医院考虑小肠疾病进行VCE、DBE、CTE检查至少其中一项及多项的受检者1108例,其中VCE368例、DBE361例、CTE379例,进行回顾性分析。结果全小肠检查完成率VCE为93.75%,与DBE比较有明显差异(P<0.01),两者在病变检出率、病因诊断率均有较高的比例。对不明原因的腹痛患者,医生和患者更多选择先做VCE检查。而对怀疑及诊断克罗恩病的患者,因担心胶囊滞留的风险,更多选择了DBE检查。VCE在炎症糜烂、血管畸形、血管显露、淋巴管扩张的诊断率明显高于DBE(P<0.01)。DBE在溃疡、腺癌、憩室、血管瘤的诊断率明显高于VCE(P<0.01)。DBE在克罗恩病、间质瘤的诊断有优势(P<0.05)。随着小肠检查从VCE、DBE、CTE单一检查到三项检查的使用,小肠疾病的病因诊断率不断提高达到87.01%。尤其是进行上述三项检查与只做DBE检查比较,诊断率从72.30%提高到87.01%,差异有统计学意义(P<0.01)。结论针对不同疾病,VCE、DBE、CTE检查各有优势。对不同的患者有针对性的选择合适的小肠检查方法,采取优化的联合序贯检查策略,合适的检查时机,良好的肠道准备,均可以提高疾病诊断水平,和检查的性价比,减少并发症的发生。
ObjectiveTo retrospectively analyze the clinical manifestation and type of small intestinal diseases, and to explore how to improve the diagnostic rate of small intestinal diseases by effectively using capsule endoscopy(VCE), double-balloon enteroscopy (DBE), and computed tomoimagedata enterography (CTE).MethodsFrom January 2015 to June 2022, 1108 patients underwent small intestinal examination at Academy of Medical Sciences & Sichuan Provincial People's Hospital. These included 368, 361, and 379 cases who underwent VCE, DBE, and CTE, respectively.ResultsThe completion rate of small intestine examination by VCE was 93.75%, which was significantly different from that by DBE (P<0.01). However, both of them had a high detection rate of lesions and diagnosis rate of etiology. The diagnostic rates of inflammatory erosion, vascular malformation, vascular exposure, and lymphatic dilatation by VCE were significantly higher than those by DBE (P<0.01). The diagnostic rates of ulcer, adenocarcinoma, diverticulum, and hemangioma by DBE were significantly higher than those by VCE (P<0.01). DBE has advantages in the diagnosis of Crohn's disease and stromal tumors (P<0.05). When all the three examinations were combined, the diagnosis rate of small intestinal diseases increased to 87.01%;compared with the diagnosis rate by DBE, the difference was statistically significant (P<0.01).ConclusionVCE, DBE, and CTE have their own advantages in detecting different diseases. Appropriate small intestine examination, application of optimized combined sequential examination strategy, suitable testing time, and good bowel preparation can improve the level of diagnosis, raise the cost performance of examination, and decrease the incidence rate of complications.
作者
邱春华
张志宏
Chunhua Qiu;Zhihong Zhang(Department of Gastroenterology,Sichuan Academy of Medical Sciences,Sichuan Provincial People's Hospital,Chengdu 610072,China)
出处
《中华临床医师杂志（电子版）》
北大核心
2023年第9期948-954,共7页
Chinese Journal of Clinicians(Electronic Edition)
基金
四川省科技厅重点研发项目资助(2023YFS0198)。
关键词
小肠疾病
胶囊内镜
双气囊小肠镜
计算机断层扫描肠成像
Small intestinal diseases
Capsule endoscopy
Double-balloon enteroscopy
Computed tomoimagedata enterography
