【摘要】：目的:通過采用三種不同的胃準備方案進行磁控膠囊內(nèi)鏡(MCE)檢查,通過對MCE圖像檢查質(zhì)量、患者耐受度、陽性病灶檢出情況及安全性評估,探討最適宜MCE檢查的胃準備方案。方法:2016年6月至2016年10月納入行MCE檢查者120例,所有受檢者需檢查前禁食8h,檢查前將其隨機分成3組:A組清水組(40例);B組西甲硅油組(40例);C組西甲硅油+鏈霉蛋白酶聯(lián)用組(40例)。分析比較三組受檢者胃內(nèi)準備的清潔度和顯示度的評分、患者耐受度、陽性病灶檢出情況及安全性等指標的差異。結(jié)果:1.本研究共計納入的120例受檢者,其中男性72例,女性48例,平均年齡47.05(20-74)歲,平均BMI 23.04±3.88 kg/m2,平均腰圍82.37±11.31cm。三組患者在年齡、性別、BMI、腰圍等基本資料無顯著性差異(P0.05)。此外,120例受檢者中,腹痛53例(44.1%),腹脹14例(11.7%),反酸惡心12例(10.0%),不明原因消化道出血或缺鐵性貧血9例(7.5%),健康體檢者32例(26.7%)。2.主要研究指標:胃內(nèi)準備圖像質(zhì)量,主要包括清潔度及顯示度的評估。三組的清潔度總體(賁門、胃底、胃體、胃角、胃竇、幽門6個主要解剖標志部位)評分分別為,A組15.83±2.41,B組21.35±1.23,C組20.82±1.90,其中A組與B組、A組與C組均具有統(tǒng)計學(xué)差異(P值均小于0.0001),而B組與C組無統(tǒng)計學(xué)差異(P0.05)。三組之間的顯示度總體(同上)評分分別為,A組10.75±2.02,B組15.20±1.32,C組15.08±1.86,其中A組與B組及C組均具有統(tǒng)計學(xué)差異(P值均小于0.0001),而B組與C組無統(tǒng)計學(xué)差異(P0.05)。3.次要研究指標:MCE陽性病灶(包括淺表性胃炎、糜爛性胃炎、胃息肉、胃潰瘍、胃癌)病灶檢出的情況,依次為A組21(52.5%),B組27(67.5%),C組21(53.8%),三組陽性病灶檢出率無統(tǒng)計學(xué)差異。其中,A組1例患者在MCE下診斷為胃惡性潰瘍,后行普通胃鏡復(fù)查取病理活檢證實為胃印戒細胞癌。該患者在2月后死亡。4.安全性指標:納入的120例受試者均順利完成檢查,檢查過程中僅有1例(1/120,0.8%)患者因幽門的炎癥性水腫引起的幽門狹窄,導(dǎo)致膠囊無法通過胃腔,后行電子胃鏡取出。其余患者在檢查過程中及檢查結(jié)束后的2周隨訪過程中無明顯不適及不良事件發(fā)生。結(jié)論:西甲硅油+清水方案相對于單用清水方案而言,可顯著提高磁控膠囊內(nèi)鏡檢查的胃準備效果,而加用鏈霉蛋白酶并沒有顯著提高胃粘膜的清潔度及可視度。因此我們推薦磁控膠囊內(nèi)鏡胃準備過程中采用西甲硅油+清水方案作為胃準備的常規(guī)方案。
[Abstract]:Objective: to evaluate the quality of MCE image, patient tolerance, positive lesion detection and safety by using three different gastric preparation schemes for magnetic controlled capsule endoscopy (MCE). To explore the most suitable gastric preparation scheme for MCE examination. Methods: from June 2016 to October 2016, 120 patients underwent MCE examination. All the subjects had to fast for 8 hours before examination. They were randomly divided into three groups: group A, clear water group (40 cases,); B group, 40 cases); Group C (40 cases) were treated with strepsin. The scores of cleanliness and display degree of gastric preparation, patient tolerance, positive lesion detection and safety were analyzed and compared among the three groups. The result is 1: 1. A total of 120 subjects were included in this study, including 72 males and 48 females, with an average age of 47.05 (20-74) years and an average BMI of 23.04 鹵3.88 kg/m2, with an average waist circumference of 82.37 鹵11.31 cm. There was no significant difference in age, sex and BMI, waist circumference among the three groups (P0.05). In addition, there were 53 cases of abdominal pain (44.1%), 14 cases of abdominal distension (11.7%), 12 cases of acid regurgitation (10.0%), 9 cases of unknown gastrointestinal bleeding or iron deficiency anemia (7.5%). 32 cases (26.7%) were healthy. Main outcome measures: image quality of gastric preparation, including the assessment of cleanliness and display. The total cleanliness of the three groups (cardia, fundus, body, angle, antrum and pylorus) were 15.83 鹵2.41 and 21.35 鹵1.23 in group B, 20.82 鹵1.90 in group A and B, respectively. There was statistical difference between group A and group C (P < 0.0001), but there was no statistical difference between group B and group C (P0.05). The overall (ibid.) scores of the three groups were as follows: group A, 10.75 鹵2.02mb, group B, 15.20 鹵1.32, group C 15.08 鹵1.86.The difference between group A and group B and group C was statistically significant (P < 0.0001). There was no statistical difference between group B and group C (P0.05). Secondary outcome measures: MCE positive lesions (including superficial gastritis, erosive gastritis, gastric polyp, gastric ulcer, gastric cancer) were detected in group A 21 (52.5%), B 27 (67.5%). In group C, 21 (53.8%), there was no significant difference in the detection rate of positive lesions among the three groups. One patient in group A was diagnosed as gastric malignant ulcer under MCE, and then confirmed as gastric signet ring cell carcinoma by general gastroscopy. The patient died two months later. Safety measures: all 120 subjects successfully completed the examination. During the examination, only one patient (1 / 1200.8%) had pyloric stenosis caused by inflammatory edema of the pylorus, resulting in the capsule being unable to pass through the stomach cavity. After the electronic gastroscope removed. No significant discomfort or adverse events occurred in the other patients during the examination and 2 weeks follow-up after the examination. Conclusion: compared with the single use of clear water, the methylene silicone oil regimen can significantly improve the gastric preparation effect of magnetic control capsule endoscopy, but the addition of strepsin did not significantly improve the cleanliness and visibility of gastric mucosa. Therefore, we recommend the use of methylsiloxane oil as a routine regimen for gastric preparation during endoscopic gastric preparation of Magnetron capsule.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R573

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