發(fā)布時(shí)間：2018-04-16 21:35

  本文選題：膠囊內(nèi)鏡 + 小腸疾病�。� 參考：《河北醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：小腸冗長（全長約5~7米），腸管呈盤曲折疊式排列、解剖位置較深，使傳統(tǒng)檢查手段的應(yīng)用受到較大程度的限制，因此臨床上一直較難準(zhǔn)確診斷小腸疾病，而膠囊內(nèi)鏡這一全新、無創(chuàng)、全消化道檢查手段的問世，為小腸疾病的直視下診斷提供了重要方法，使小腸疾病的診斷產(chǎn)生了質(zhì)的飛躍。國內(nèi)外已有大量文獻(xiàn)證實(shí)膠囊內(nèi)鏡對(duì)小腸疾病有較高的診斷價(jià)值，但是關(guān)于行膠囊內(nèi)鏡檢查后較大樣本量的隨訪研究較少，本文對(duì)280例行膠囊內(nèi)鏡檢查者的臨床資料進(jìn)行分析，并結(jié)合隨訪情況，確定膠囊內(nèi)鏡與最終臨床診斷符合情況，進(jìn)一步探討膠囊內(nèi)鏡在小腸疾病中的應(yīng)用價(jià)值。 方法：對(duì)2007年04月至2013年11月間于河北醫(yī)科大學(xué)第二醫(yī)院行國產(chǎn)OMOM膠囊內(nèi)鏡檢查的280例受檢者進(jìn)行回顧性分析和隨訪，隨訪時(shí)間從5個(gè)月至7年不等，其中男性171例，女性109例，年齡17～80歲之間，最后對(duì)相關(guān)結(jié)果應(yīng)用統(tǒng)計(jì)學(xué)方法進(jìn)行分析。 結(jié)果： 1膠囊內(nèi)鏡運(yùn)行時(shí)間：膠囊內(nèi)鏡在食道內(nèi)平均運(yùn)行時(shí)間28.7±10.8(4～54)s，胃內(nèi)運(yùn)行時(shí)間48.5±40.8(2～189)min，到達(dá)幽門的時(shí)間49.3±41.5(2.2～189.1)min；到達(dá)回盲瓣的時(shí)間為258.7±60.8(59～499)min，小腸內(nèi)運(yùn)行時(shí)間304.8±61.2(64.7～501.4)min。 2膠囊內(nèi)鏡檢查成功率99.3%（278/280），病變檢出率66.4%（186/280），漏診率0.7%（2/280）,過瓣率為87.5%（245/280）。 3膠囊內(nèi)鏡小腸病變檢出結(jié)果：膠囊內(nèi)鏡病變總檢出率66.4%（186/280），主要檢出病變?yōu)檠懿∽冋?0.4%（57/280）、非特異性炎癥占11.8%（33/280）、潰瘍性病變占9.6%（27/280）、占位性病變22例占7.9%（22/280)，其它檢出病變依次為息肉5.0%（14/280）、淋巴管擴(kuò)張4.3%（12/280）、克羅恩病2.5%（7/280）、活動(dòng)性出血1.8%（5/280)、憩室1.1%（3/280）、黃斑瘤1.1%（3/280）、間質(zhì)瘤0.7%（2/280)、脂肪瘤0.4%（1/280）。 4不同癥狀三組膠囊內(nèi)鏡檢查結(jié)果：①不明原因消化道出血組病變檢出率70.0%（140/200），以血管病變25.5%（51/200）、非特異性炎癥10.5%（21/200）、占位性病變9.5%（19/200）、潰瘍性病變9.0%（18/200）為主；②不明原因腹痛組病變檢出率為58.6%（34/58）。以小腸非特異性炎癥13.8%（8/58）、小腸潰瘍性病變12.1%（7/58）較為常見；③其他癥狀組病變檢出率54.5%（12/22）。三癥狀組病變檢出率進(jìn)行卡方檢驗(yàn)無顯著差異。 5膠囊內(nèi)鏡并發(fā)癥：3例受檢者（1.1%）發(fā)生膠囊滯留，均通過手術(shù)取出滯留膠囊內(nèi)鏡。 6隨訪：膠囊內(nèi)鏡檢查后隨訪率為60.4%（169/280），青少年組、中年組、老年組隨訪率分別為54.9%（39/71）、57.9%(81/140）、71.0%(49/69)，各年齡組間行卡方檢驗(yàn)無顯著差異。 行膠囊內(nèi)鏡檢查后共51例患者接受進(jìn)一步診治并確診，27例首先行小腸鏡檢查，6例首先行血管造影檢查，11例直接行手術(shù)剖腹探查和治療者，5例可疑NASIDS相關(guān)性潰瘍、2例可疑過敏性紫癜者行診斷性治療試驗(yàn)。最終共確診51例，分別為潰瘍性病變7例、非特異性炎癥6例、血管擴(kuò)張6例、NASIDS相關(guān)性潰瘍5例、憩室5例、血管畸形3例、血管瘤3例、間質(zhì)瘤3例、息肉2例、2例過敏性紫癜、黃斑瘤1例、脂肪瘤1例、隱源性多灶性潰瘍性狹窄性小腸炎1例、神經(jīng)內(nèi)分泌腫瘤1例，另外5例患者未見異常。 7膠囊內(nèi)鏡診斷與最后診斷的符合情況：膠囊內(nèi)鏡在小腸疾病診斷中的診斷符合率為76.5%(39/51）、其中不明原因消化道出血患者組診斷符合率為88.9%（32/36）。 結(jié)論： 1膠囊內(nèi)鏡對(duì)小腸疾病有較高的診斷價(jià)值，，特別是對(duì)不明原因消化道出血患者的診斷。 2應(yīng)重視膠囊內(nèi)鏡檢查后的隨訪工作。
[Abstract]:Objective: the small intestine long (total length of about 5~7 meters), a coiled intestinal folding arrangement, anatomy is deep, the application of traditional examination method is more limited, so the clinical practice has been more difficult to accurately diagnose small bowel disease, and capsule endoscopy in this new, non-invasive examination means, the advent of the whole digestive tract. An important method to provide diagnosis of small bowel diseases under direct vision, make the diagnosis of small bowel diseases had a qualitative leap. A lot of literature at home and abroad have been confirmed to have higher diagnostic value of capsule endoscopy in small bowel diseases, but not a follow-up study of larger sample size for capsule endoscopy examination, the clinical data of 280 cases of capsule endoscopy the analysis, combined with the follow-up situation, determine the capsule endoscopy with the final clinical diagnosis, to further explore the application value of capsule endoscopy in small intestinal diseases.
Methods: in 2007 04 months to November 2013 in the second hospital of Hebei Medical University underwent OMOM capsule endoscopy examination of 280 cases of subjects were retrospectively analyzed and followed up. The follow-up time ranged from 5 months to 7 years, there were 171 males and 109 females, between the age of 17~80 years, the application of the statistical method carries on the analysis.
Result:
Running time: 1 capsule endoscopy capsule endoscopy in the esophagus the average running time of 28.7 (4~54 + 10.8) s, intragastric running time 48.5 + 40.8 (2~189) min, arrival time of 49.3 + 41.5 HP (2.2 ~ 189.1) min; at the ileocecal valve time was 258.7 + 60.8 (min 59~499), small intestine in the running time of 304.8 + 61.2 (64.7 ~ 501.4) min.
The success rate of 2 capsule endoscopy was 99.3% (278/280), the detection rate of lesions was 66.4% (186/280), the rate of missed diagnosis was 0.7% (2/280), and the rate of over valve was 87.5% (245/280).
Capsule endoscopy small bowel lesions were detected in 3 Results: the total detection rate of 66.4% lesions of capsule endoscopy (186/280), the main lesions of vascular lesions accounted for 20.4% (57/280), nonspecific inflammation accounted for 11.8% (33/280), ulcerative lesions accounted for 9.6% (27/280), lesions in 22 cases accounted for 7.9% (22/280), other lesions in 5% polyps (14/280), lymphatic dilatation in 4.3% (12/280), 2.5% Crohn's disease (7/280), active bleeding in 1.8% (5/280), 1.1% (3/280), macular diverticulum in 1.1% (3/280), 0.7% stromal tumors (2/280), 0.4% lipoma (1/280).
4 different symptoms of the three groups of capsule endoscopy results: obscure gastrointestinal bleeding group lesion detection rate of 70% (140/200), 25.5% (51/200) in vascular disease, nonspecific inflammation, 10.5% (21/200) lesions were 9.5% (19/200), ulcerative lesions in 9% (18/200); group II unexplained abdominal pain the detection rate of lesions was 58.6% (34/58) in small intestine. Nonspecific inflammation in 13.8% (8/58), small intestinal ulcer lesions 12.1% (7/58) are common; other symptoms group lesion detection rate of 54.5% (12/22). The three group of symptoms of disease detection rate by chi square test showed no significant difference.
5 capsule endoscopy complications: 3 cases (1.1%) had capsule retention, and all the capsule endoscopy was taken out by operation.
6 follow up: after capsule endoscopy, the follow-up rate was 60.4% (169/280). The follow-up rates in the adolescent group, the middle-aged group and the elderly group were 54.9% (39/71), 57.9% (81/140), and 71% (49/69), respectively. There was no significant difference in Chi square test among all age groups.
For capsule endoscopy after a total of 51 patients underwent further treatment and diagnosis, 27 cases of first endoscopy, 6 cases of first line angiography, 11 cases underwent surgical exploration and treatment of direct laparotomy, 5 cases of suspected NASIDS related ulcer, 2 cases of suspected allergic purpura underwent diagnostic treatment. The final test confirmed 51 cases were ulcerative lesions in 7 cases, 6 cases of nonspecific inflammation, vascular dilatation in 6 cases, 5 cases of NASIDS related peptic ulcer, diverticulum in 5 cases, 3 cases of vascular malformation, 3 cases of hemangioma, 3 cases of stromal tumors, 2 cases of polyp, 2 cases of allergic purpura, 1 cases of macular tumor, 1 cases of lipoma, 1 cases of cryptogenic multifocal ulcerative enteritis stenosis, 1 cases of neuroendocrine tumors, and 5 patients were abnormal.
7 the coincidence of capsule endoscopy diagnosis and final diagnosis: the coincidence rate of capsule endoscopy in the diagnosis of small intestinal diseases was 76.5% (39/51), and the diagnostic coincidence rate of patients with obscure gastrointestinal bleeding was 88.9% (32/36).
Conclusion:
1 capsule endoscopy is of high diagnostic value for small intestinal diseases, especially for patients with unexplained gastrointestinal bleeding.
2 should pay attention to the follow-up work after the capsule endoscopy.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R574.5

【引證文獻(xiàn)】

相關(guān)期刊論文 前1條

1 黃崧;;隱源性消化道出血的病因分析及治療[J];轉(zhuǎn)化醫(yī)學(xué)電子雜志;2015年08期

本文編號(hào)：1760692