胶囊内镜在小肠疾病诊疗中的作用-5.pptVIP

CMV ileitis Cytomegalovirus (CMV) enteritis usually occurs in immunocompromisedpatients. ACS and chronic renal failure may be risk factors for CMV enteritis. The GI tract may be affected anywhere from the esophagus to the colon. Bleeding is the most common clinical symptom of CMV enteritis, and the most commonly affected segment of the GI tract is the colon. CMV antigenemia assay is one of the most widely used methods to detect CMV activation, but it is of little value in predicting or diagnosing CMV enteritis. The endoscopic findings of CMV enteritis include erosion, ulceration, pseudotumor formation, and even perforation. CE findings of the lower small bowel. Active bleeding was observed. Single-balloon endoscopic findings of the ileum. Bleeding from a large girdle ulcer was observed Biopsy specimens obtained from the ulcer showed enlarged endothelial cells with nuclear inclusion bodies that were positive for CMV large girdle ulcer was observed in the resected ileum 伪膜性肠炎 Ectopic pancreas at the jejunum Polypoid Diffuse polypoid lesions visible in duodenum at upper endoscopy. Capsule endoscopy examination showing multiple polypoid lesions in the small bowel’s wall. Small polypoid lesions at large bowel examination by colonoscopy. tubular adenoma A protruding lesion near the terminal ileum that was detected by the second capsule endoscopy examination 小肠血管发育不良 小肠类癌 移植物抗宿主病累及小肠 胶囊内镜与其他小肠检查方法的比较 胶囊内镜为小肠疾病的诊断提供了一个全新的检查手段，它对小肠疾病的检出率较其他传统检查方法有所提高。但是胶囊内镜自身的某些局限性，如内镜移动的不可控制性、肠道积液对观察的影响、图像分辨率不如电子内镜，无活动功能及可能产生胶囊肠道梗阻或滞留等，因此根据临床实际情况结合应用胶囊内镜和双气囊小肠镜，必要时辅以CT小肠造影、血管造影等检查项目，是提高小肠疾病诊断水平的有效方法。 大量临床应用表明，胶囊内镜检查是安全而舒适的，但个别检查中可能发生无法预料或不能防范的不良后果如：高分子材料过敏；检查过程中出血、穿孔（及时和迟发穿孔）；检查过程中发生无法预料或不能防范的病理改变；胶囊不能排出；检查失败。 有先天消化道畸形、小肠憩室、肠瘘等疾病的患者接受胶囊内镜的检查可能会引发肠道梗阻，致使智能胶囊不能排出体外，此时为了治疗原发病也需要进行外科手术，不属于该项检查的不良后果。 胶囊内镜的滞留 2005年ICCE定义为吞服后2周仍未排出体外。 滞留率1.4%（长海医院13142例） 主要病因：克罗恩病、小肠肿瘤和NSAID相关肠炎 目前无公认的预防措施 处理方法：外科手术、内镜取出。 检查前须告知患者病签署知情同意书 不同受检者胶囊内镜的滞留率 受检者、患者 滞留率 健康受检者 0 所有受检者 0.75% 可疑克罗恩病 1.4% 克罗恩病 8% 粪便潜血阳性者