【摘要】：目的探討雙氣囊小腸鏡(DBE)在小腸出血(SBB)患者治療中的應用價值及安全性,分析SBB患者的病因特點。方法收集2015年6月-2016年7月南京醫(yī)科大學第二附屬醫(yī)院診斷為SBB的52例接受DBE檢查的患者資料,回顧性分析診治結果及并發(fā)癥發(fā)生和隨訪情況。結果該研究共納入患者52例(男28例,女24例),年齡16~82(51.0±17.0)歲,發(fā)病時間1~14(8.3±4.0)d。顯性消化道出血37例,隱性消化道出血15例。經口進鏡25例,經肛進鏡21例,經結腸造瘺口進鏡2例,口+肛4例。DBE的診斷率為76.9%(40/52),并發(fā)癥發(fā)生率為5.8%(3/52),小腸鏡檢查陰性患者小腸再出血率16.7%(2/12)。5例小腸多發(fā)性息肉予以內鏡黏膜切除術(EMR),2例小腸毛細血管擴張癥給予氬離子凝固術(APC)。1例空腸癌伴膠囊滯留予以取出膠囊,14例(26.9%)接受手術治療。SBB病因為腫瘤(n=9,17.3%)、潰瘍(n=9,17.3%)、克羅恩病(n=7,13.5%)、息肉(n=5,9.6%),憩室/血管畸形(n=4,7.7%)等。SBB患者中位隨訪時間(8.3±2.0)個月,范圍4~10個月,死亡2例,死因為小腸癌再出血。結論 DBE診斷SBB及行內鏡下治療安全有效,即使在困難病例Roux-en-Y術后。SBB病因以腫瘤、潰瘍、克羅恩病較為常見,小腸鏡檢查陰性患者仍有小腸再出血可能,血管病變可能性大。
[Abstract]:Objective to evaluate the clinical value and safety of double balloon enteroscopy (DBE) in the treatment of small intestinal hemorrhage (SBB) and to analyze the etiological characteristics of SBB. Methods from June 2015 to July 2016, 52 patients with SBB diagnosed in the second affiliated Hospital of Nanjing Medical University were examined by DBE. The results of diagnosis and treatment, the occurrence and follow-up of complications were analyzed retrospectively. Results A total of 52 patients (M 28, F 24) were enrolled in this study. The age was 161.0 鹵17.0 years old and the onset time was 1: 14 (8.3 鹵4.0) days. There were 37 cases of dominant gastrointestinal bleeding and 15 cases of recessive gastrointestinal bleeding. There were 25 cases of transoral endoscopy, 21 cases of transanal endoscopy and 2 cases of colostomy. The diagnostic rate of .DBE was 76.9% (40 / 52), the incidence of complications was 5.8% (3 / 52). The rate of small intestinal rebleeding in patients with negative enteroscopy was 16.7% (2 / 12). 5 cases of multiple polyps were treated with endoscopic mucosal excision. 2 cases of small intestine capillary dilatation were treated with argon ion coagulation. 14 cases (26.9%) underwent surgical treatment. The etiology of (APC) was tumor (917.3%), ulcer (917.3%), Crohn's disease (713.5%), polyp (59.6%), diverticulum / vascular malformation (47.7%) and so on. The median follow-up time was (8.3 鹵2.0) months. The range of 4 ~ 10 months, 2 cases of death, because of small bowel cancer bleeding again. Conclusion DBE is safe and effective in the diagnosis of SBB and endoscopic treatment. Even if the etiology of Roux-en-Y after Roux-en-Y is tumor, ulcer and Crohn's disease, the patients with negative enteroscopy still have the possibility of small intestinal rebleeding and the possibility of angiopathy.
【作者單位】： 安徽省宿州市立醫(yī)院消化內科;南京醫(yī)科大學第二附屬醫(yī)院消化醫(yī)學中心;
【分類號】：R574.5

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