本文選題：膠囊內(nèi)鏡 + 小腸疾病��； 參考：《中南大學(xué)》2014年碩士論文

【摘要】：目的：探討國產(chǎn)OMOM膠囊內(nèi)鏡對小腸疾病的診斷價(jià)值及安全性。 方法：回顧性分析我院2011年1月至2014年1月因消化系統(tǒng)癥狀就診行胃鏡、結(jié)腸鏡等常規(guī)檢查沒有可解釋臨床癥狀的陽性發(fā)現(xiàn)的疑診小腸疾病208例患者的臨床資料、OMOM膠囊內(nèi)鏡檢查結(jié)果,并進(jìn)行電話隨訪以了解其診斷的準(zhǔn)確性及疾病轉(zhuǎn)歸。并與同期所做的全消化道鋇餐或腹部CT或雙氣囊小腸鏡對小腸疾病的病因診斷率進(jìn)行比較。 結(jié)果： 1.208例患者,203例檢查成功,檢查成功率97.59%(203/208)。老年人以O(shè)GIB為檢查原因的比例明顯高于兒童、中青年(64.06%vs34.72%),而兒童、中青年則以腹痛為檢查原因的比例明顯高于老年人(56.25%vs31.25%)。 2.膠囊內(nèi)鏡對小腸病變的總病變檢出率為66.01%(134/203),前四位陽性發(fā)現(xiàn)分別是小腸潰瘍、黏膜炎癥、血管畸形、占位性病變�？偛∫蛟\斷率為35.96%(73/203),前四位病因診斷分別是為小腸克羅恩病、血管畸形、小腸腫瘤、寄生蟲病。 3.膠囊內(nèi)鏡對各組小腸疾病的檢出結(jié)果： ①膠囊內(nèi)鏡對不明原因消化道出血組的檢出結(jié)果：病變檢出率為80.68%(71/88),陽性發(fā)現(xiàn)主要有血管畸形、占位性病變、小腸潰瘍、黏膜炎癥；病因診斷率為52.27%(46/88),病因診斷主要有血管畸形、小腸腫瘤、小腸克羅恩病。②膠囊內(nèi)鏡對腹痛組的檢出結(jié)果：病變檢出率為55.00%(55/100),陽性發(fā)現(xiàn)主要有小腸潰瘍、黏膜炎癥、血管病變、小腸憩室；病因診斷率為23.00%(23/100),病因診斷主要有小腸克羅恩病、寄生蟲病、小腸憩室等；③膠囊內(nèi)鏡對腹瀉組的檢出結(jié)果：病變檢出率為61.54%(8/13),陽性發(fā)現(xiàn)主要有黏膜炎癥、小腸潰瘍等；病因診斷率為30.77%(4/13),病因診斷有小腸克羅恩病,嗜酸細(xì)胞性腸炎。 4.膠囊內(nèi)鏡與全消化道鋇餐、腹部CT、雙氣囊小腸鏡對小腸疾病診斷率比較： 全消化道鋇餐病因診斷率8.04%(9/112),膠囊內(nèi)鏡36.61%(41/112),兩者比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),兩者聯(lián)合診斷的病因診斷率為38.39%(43/112),與單純膠囊內(nèi)鏡比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)；腹部CT的病因診斷率16.67%(14/84),膠囊內(nèi)鏡29.76%(25/84),兩者比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),兩者聯(lián)合診斷的病因診斷率為32.14%(27/84),與單純膠囊內(nèi)鏡比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)；；雙氣囊小腸鏡的病因診斷率53.85%(7/13),膠囊內(nèi)鏡53.85(7/13),兩者比較差異無統(tǒng)計(jì)學(xué)意義(P0.05),兩者聯(lián)合診斷的病因診斷率為69.23%(9/13),與單純膠囊內(nèi)鏡比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。 5.膠囊內(nèi)鏡的鏡下診斷與病理診斷符合率為66.67%(14/21),對小腸間質(zhì)瘤的符合率為70%(7/10)。 6.全小腸檢查率66.70%(136/203),胃運(yùn)行時(shí)間超過45min、小腸克羅恩病是膠囊內(nèi)鏡未完成全小腸檢查的危險(xiǎn)因素。 7.膠囊內(nèi)鏡的耐受性及并發(fā)癥：3例患者發(fā)生膠囊滯留,膠囊滯留率1.47%(3/203),只有1例患者最終發(fā)生急性腸梗阻。其他患者耐受性好。 結(jié)論： 1.膠囊內(nèi)鏡是診斷小腸疾病有效的檢查手段,膠囊內(nèi)鏡對小腸疾病的病變檢出率及病因診斷率較高。前四位的病因診斷依次為小腸克羅恩病、血管畸形、小腸腫瘤、寄生蟲病。 2.膠囊內(nèi)鏡對不明原因消化道出血組的病變檢出率及病因診斷率均高于腹痛組,不明原因消化道出血組前四位的病因診斷依次是血管畸形、小腸腫瘤、小腸克羅恩病、小腸糜爛出血。 3.胃運(yùn)行時(shí)間超過45min、小腸克羅恩病是小腸檢查不完全的危險(xiǎn)因素。 4.膠囊內(nèi)鏡對小腸疾病的病因診斷率高于全消化道鋇餐、腹部CT；膠囊內(nèi)鏡聯(lián)合全消化道鋇餐或腹部CT檢查均可提高診斷率。本研究中膠囊內(nèi)鏡與雙氣囊小腸鏡對小腸疾病的病因診斷率相當(dāng)。 5.膠囊內(nèi)鏡是一種較安全的檢查方法,患者耐受好,并發(fā)癥發(fā)生率低。
[Abstract]:Objective: To evaluate the diagnostic value and safety of domestic OMOM capsule endoscopy in small bowel diseases.
Methods: the clinical data of 208 patients with suspected small intestinal diseases, such as gastroscopy and colonoscopy, were reviewed from January 2011 to January 2014 in our hospital. The clinical data of 208 patients with suspected small intestinal diseases, which had no interpretable clinical symptoms, were examined, and the results of the OMOM capsule endoscopy were carried out to understand the accuracy of the diagnosis and the change of the disease. The diagnosis rate of intestinal diseases was compared with that of the whole digestive tract barium meal or abdominal CT or double balloon enteroscopy.
Result:
In 1.208 cases, 203 cases were successfully examined and the rate of examination success was 97.59% (203/208). The proportion of the elderly with OGIB was significantly higher than that of children, middle and young (64.06%vs34.72%), while in children, the proportion of abdominal pain was significantly higher in the middle and young people than in the elderly (56.25% vs31.25%).
The total detection rate of 2. capsule endoscopy for small intestinal lesions was 66.01% (134/203). The first four positive findings were small intestinal ulcer, mucosal inflammation, vascular malformation and occupying lesion. The total etiological diagnosis rate was 35.96% (73/203). The first four etiological diagnoses were small intestinal Crohn's disease, vascular malformation, small intestinal tumor, and parasitic disease.
3. capsule endoscopy for detection of intestinal diseases in each group:
(1) the detection results of the capsule endoscopy in the unexplained gastrointestinal bleeding group: the detection rate was 80.68% (71/88). The positive findings were mainly vascular malformation, occupying lesion, small intestinal ulcer and mucous membrane inflammation; the etiological diagnosis rate was 52.27% (46/88). The etiological diagnosis was mainly vascular malformation, small intestine tumor, and Crohn's disease of small intestine. The detection rate of the group was 55% (55/100). The positive findings were mainly small intestinal ulcer, mucous membrane inflammation, vascular disease and small intestinal diverticulum, the diagnosis rate was 23% (23/100). The etiological diagnosis mainly consisted of small intestine Crohn's disease, parasitic disease and small intestinal diverticulum, and the detection result of capsule endoscopy for diarrhea group was 61.. The detection rate of pathological changes was 61. 54% (8/13), most of the positive findings were mucosal inflammation and intestinal ulcers. The etiological diagnosis rate was 30.77% (4/13). The etiological diagnosis was small intestinal Crohn's disease and eosinophilic enteritis.
4. comparison of capsule endoscopy and whole gastrointestinal barium meal, abdominal CT and double balloon enteroscopy in the diagnosis of small bowel diseases:
The diagnostic rate of barium meal in the whole digestive tract was 8.04% (9/112) and capsule endoscopy 36.61% (41/112). The difference was statistically significant (P0.05). The diagnostic rate of the combined diagnosis was 38.39% (43/112), compared with the capsule endoscopy (P0.05); the diagnostic rate of abdominal CT was 16.67% (14/84) and capsule endoscopy 29.76% (25/84). The difference was statistically significant (P0.05). The diagnostic rate of the combined diagnosis was 32.14% (27/84), and the difference was statistically significant (P0.05) compared with the simple capsule endoscopy (P0.05); the etiological diagnosis rate of the double balloon enteroscopy was 53.85% (7/13), and the capsule endoscopy 53.85 (7/ 13) had no statistical difference (P0.05), and both were diagnosed jointly. The etiological diagnosis rate was 69.23% (9/13), and there was no significant difference compared with capsule endoscopy (P0.05).
5. the coincidence rate of endoscopic diagnosis and pathological diagnosis of capsule endoscopy was 66.67% (14/21), and the coincidence rate for small intestinal stromal tumors was 70% (7/10).
6. the total small bowel examination rate was 66.70% (136/203), and the gastric operation time was more than 45min. Crohn's disease of small intestine was a risk factor for complete small bowel examination without capsule endoscopy.
7. capsule endoscopes were tolerated and complications: 3 patients had capsule retention, the capsule retention rate was 1.47% (3/203), and only 1 patients eventually had acute intestinal obstruction. Other patients were well tolerated.
Conclusion:
1. capsule endoscopy is an effective method for the diagnosis of small intestinal diseases. The detection rate and the diagnostic rate of the disease are higher in capsule endoscopy. The first four etiological diagnoses are small intestinal Crohn's disease, vascular malformation, small intestinal tumor, and parasitic disease.
The detection rate and etiological diagnosis rate of the 2. capsule endoscopy were higher than those in the abdominal pain group. The first four of the unexplained gastrointestinal bleeding group were vascular malformation, small intestinal tumor, small intestine Crohn's disease, and intestinal erosion bleeding.
3. gastric operation time exceeds 45min. Crohn's disease is a risk factor for incomplete detection of small intestine.
The diagnostic rate of 4. capsule endoscopy is higher than the whole digestive tract barium meal, abdominal CT, capsule endoscopy combined with full gastrointestinal barium meal or abdominal CT examination can improve the diagnostic rate. In this study, the diagnosis rate of the capsule endoscopy and double balloon enteroscopy for the cause of small intestinal disease is equal.
5. capsule endoscopy is a safer method of examination. Patients are well tolerated and the incidence of complications is low.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R574

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 劉月賓;徐輝;;膠囊內(nèi)鏡在小腸腫瘤診斷中的價(jià)值[J];重慶醫(yī)學(xué);2011年07期

2 智發(fā)朝;;小腸疾病的檢查方法與評價(jià)[J];腹部外科;2006年06期

3 張智高;尚慶玲;李群;魏志;李文波;劉長江;尚瑞蓮;;膠囊內(nèi)鏡技術(shù)研究進(jìn)展[J];國際消化病雜志;2013年03期

4 衛(wèi)煒;戈之錚;高云杰;顧靜莉;胡運(yùn)彪;蕭樹東;;膠囊內(nèi)鏡檢查對消化道轉(zhuǎn)運(yùn)時(shí)間的影響[J];上海交通大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2006年05期

5 陳健,王進(jìn),季燕;小腸出血87例分析[J];中國實(shí)用內(nèi)科雜志;1999年01期

6 王艷梅;李楠;翟俊山;朱建華;陳偉;李娜;;國產(chǎn)OMOM膠囊內(nèi)鏡的臨床應(yīng)用體會[J];胃腸病學(xué)和肝病學(xué)雜志;2010年01期

7 謝巧玉;王勝炳;張德強(qiáng);曾安祥;陳偉旋;楊惠琴;;膠囊內(nèi)鏡對消化道疾病的診斷價(jià)值[J];現(xiàn)代消化及介入診療;2010年04期

8 衛(wèi)煒;戈之錚;高云杰;胡運(yùn)彪;蕭樹東;;膠囊內(nèi)鏡對不明原因消化道出血的診斷價(jià)值研究[J];中國消化內(nèi)鏡;2007年05期

9 李曉波;戈之錚;戴軍;高云杰;劉文忠;胡運(yùn)彪;蕭樹東;;膠囊內(nèi)鏡檢查對雙氣囊小腸鏡進(jìn)鏡方式選擇的指導(dǎo)作用[J];世界華人消化雜志;2006年18期

10 程英升;宋富珍;;小腸疾病影像學(xué)診斷新進(jìn)展[J];世界華人消化雜志;2007年07期

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