本文選題：不明原因消化道出血 + 雙氣囊小腸鏡��； 參考：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：背景及目的 背景：不明原因消化道出血（OGIB, Obscure gastrointestinal bleeding）病因多由小腸疾病引起。小腸是人體最長的器官，所在部位較深，一般檢查方法難以到達(dá)整個小腸，所以小腸疾病的診斷和治療成為消化系統(tǒng)疾病的難點，傳統(tǒng)的檢測方法對小腸疾病的病變診斷率較低。自電子小腸鏡（雙氣囊、單氣囊）及膠囊內(nèi)鏡問世以來，，小腸鏡可以在內(nèi)鏡下直接觀察全小腸粘膜、提供組織學(xué)檢查和內(nèi)鏡下治療，膠囊內(nèi)鏡（CE, Capsule endoscopy）檢查無創(chuàng)、無痛苦，可完成對整個消化道的檢查，小腸仿真CT(CTE, CT enterography)檢查可以明確病變的部位、管壁的厚度以及與周圍臟器之間的關(guān)系，小腸鏡與膠囊內(nèi)鏡兩種檢查方法的出現(xiàn)是21世紀(jì)初內(nèi)鏡技術(shù)發(fā)明的重大創(chuàng)新，它們?yōu)樾∧c疾病的診斷和治療提供了便利的診斷方法，而小腸仿真CT檢查是一種新興檢查技術(shù)，尤其對小腸疾病的評估起到重要作用。本研究主要研究以上三種檢查方法對OGIB的診斷價值。目的：探討不明原因消化道出血（OGIB）患者中單氣囊小腸鏡（Single-balloonenteroscopy）、膠囊內(nèi)鏡、小腸仿真CT對OGIB的陽性檢出率及診斷價值。 研究對象及方法： 1、研究對象 1.1研究對象的納入標(biāo)準(zhǔn)：經(jīng)常規(guī)電子胃鏡及電子結(jié)腸鏡檢查后出血原因仍舊不明確（隱性/顯性）的持續(xù)或反復(fù)發(fā)作的消化道出血患者。 1.2研究對象的選取 本研究屬于回顧性臨床研究，根據(jù)以上納入標(biāo)準(zhǔn)選取A組（SBE組）病例為2009年4月至2014年4月北京軍區(qū)總醫(yī)院消化內(nèi)科臨床診斷為OGIB患者134例，其中男性83例，女性51例；B組（CE組）病例為2010年9月至2013年10月我院OGIB患者117例；其中男性72例，女性45例。C組（CTE組）病例為2011年11月至2013年9月我院OGIB患者114例，其中男性71例，女性43例。 2、方法 134例OGIB患者接受SBE檢查，檢查方式根據(jù)臨床表現(xiàn)選擇經(jīng)口或經(jīng)肛進(jìn)鏡檢查，未發(fā)現(xiàn)病灶者，從另一側(cè)進(jìn)鏡再次檢查，經(jīng)口經(jīng)肛均檢查患者27例。117例接受CE檢查。SBE聯(lián)合CE檢查患者共16例，114例患者行小腸仿真CT檢查。SBE聯(lián)合CTE檢查患者共20例。 結(jié)果： 1、SBE組：108例患者發(fā)現(xiàn)陽性病灶，其中主要的為息肉性病變占15.7%（21/134），腸粘膜糜爛、潰瘍占20.1%（27/134），占位性病變、克羅恩病及憩室各占10.4%（14/134），血管性病變占5.2%(7/134)，間質(zhì)瘤占4.8%(6/134)，；CE組：100例患者發(fā)現(xiàn)陽性病灶，主要包括小腸潰瘍、糜爛占38.5%(45/117),息肉占7.7%(9/117)，小腸淋巴管擴(kuò)張占11.1%(13/117)，小腸血管畸形占8.5%(10/117),小腸黃色瘤占7.7%（9/117）,小腸隆起性病變占6.8%(8/117)，其中有4例發(fā)生膠囊滯留，滯留率達(dá)3.4%(4/117)；CTE組：55例發(fā)現(xiàn)陽性病灶，其中小腸炎性改變占34.2%(39/114),病變符合克羅恩病占7.9%(9/114)。 2、SBE組病灶檢出率為80.6%,病因診斷率為78.4%；CE組病灶檢出率為85.5%,病因診斷率為59.8%；CTE組病灶檢出率為48.2%，病因診斷率為13.2%。16例CE與SBE聯(lián)合做的患者進(jìn)行比較，提示SBE與CE的陽性病灶檢出率無差異，而在20例SBE與CTE同時做的患者中，SBE的陽性病灶檢出率高于CTE。 3、16例患者行SBE檢查合并CE檢查，其中有4例患者在SBE及CE檢查中診斷符合，CE主要遺漏的病變?yōu)轫液涂肆_恩病。20例患者行SBE檢查合并CTE檢查，其中有10例患者的診斷結(jié)果相同或相似，有4例患者在行CTE檢查時懷疑CD，經(jīng)過SBE檢查得到證實。CTE是一項重要的檢查工具，可以明確病變的部位、管壁的厚度，及與周圍臟器之間的關(guān)系，為小腸疾病的診斷提供了有利依據(jù)，在OGIB的診斷中CTE對克羅恩病的診斷起到了提示作用。 4、SBE組及CTE組患者檢查均較順利，CE組中2例患者發(fā)生回腸末端嵌頓，余患者膠囊均在24~72小時后成功排出體外，膠囊滯留率為3.4%（4/117），3組患者接受檢查后均無腹部不適等不良反應(yīng)及并發(fā)癥的發(fā)生。 結(jié)論： 1、本研究中SBE與CE檢查方法檢出的病因較常見的都為息肉及粘膜糜爛潰瘍病變。 2、CE病灶檢出率略高于SBE，（P0.05），但兩者之間無明顯差異。 3、小腸仿真CT在不明原因消化道出血的診斷中對克羅恩病的診斷起到了提示作用，對克羅恩病診斷價值較大。 4、SBE與CE兩種檢查方法均較可靠，但CE檢查更加方便。
[Abstract]:Background and purpose
Background: the etiology of OGIB (Obscure gastrointestinal bleeding) is mostly caused by small intestinal diseases. The small intestine is the longest organ of the human body and its location is deep. The general examination method is difficult to reach the whole small intestine. So the diagnosis and treatment of small intestine diseases become the difficulty of the digestive system disease. The traditional detection method is small. The diagnosis of intestinal diseases is low. Since the advent of electronic enteroscopy (double balloon, single balloon) and capsule endoscopy, small enteroscopy can be used to observe the whole intestinal mucosa directly under endoscopy, providing histological examination and endoscopic treatment. The capsule endoscopy (CE, Capsule endoscopy) examination is noninvasive and painless, and the whole gastrointestinal tract can be examined, small intestine can be completed. The simulation CT (CTE, CT enterography) examination can determine the location of the lesion, the thickness of the wall and the relationship with the surrounding organs. The appearance of two methods of examination of small enteroscopy and capsule endoscopy is a major innovation of the invention of the endoscopy in the early twenty-first Century. They provide a convenient diagnostic method for the diagnosis and treatment of small intestinal diseases, and the small intestine is imitated. True CT examination is an emerging examination technique, especially for the evaluation of small intestinal diseases. This study mainly studies the diagnostic value of the three methods above for the diagnosis of OGIB. Objective: To explore the single balloon enteroscopy (Single-balloonenteroscopy), capsule endoscopy, and CT of the small intestine to OGIB in the patients with unexplained digestive tract hemorrhage (OGIB). The rate of sexual detection and the value of diagnosis.
Research objects and methods:
1, the object of research
1.1 the inclusion criteria of the subjects: recurrent or repeated episodes of gastrointestinal bleeding after regular electronic gastroscopy and electronic colonoscopy, which were still unclear (recessive / dominant).
1.2 selection of research objects
This study belongs to retrospective clinical study. According to the above criteria, the A group (group SBE) was selected as 134 cases of OGIB patients in the digestive department of General Hospital of Beijing Military Region from April 2009 to April 2014, including 83 males and 51 females, and 117 cases of OGIB patients from September 2010 to October 2013 in group B (group CE), of which 72 cases were male, and 117 cases were from September 2010 to October 2013. 45 cases of female.C group (group CTE) were from November 2011 to September 2013, 114 cases of OGIB in our hospital, including 71 males and 43 females.
2, method
134 cases of OGIB patients received SBE examination. The examination methods were selected through oral or anal endoscopic examination according to clinical manifestations. The patients who had not found the lesion were examined again from the other side, 27 cases of.117 cases received CE examination and 16 cases of.SBE combined with CE examination, and 114 patients underwent small bowel simulation CT examination,.SBE combined CTE examination of 20 patients. Example.
Result錛

本文編號：1828245