双气囊推进式小肠镜对189例小肠疾病诊断价值.docVIP

双气囊推进式小肠镜对189例小肠疾病诊断价值 　　摘 要 目的：探讨双气囊推进式小肠镜（DBE）在小肠疾病诊断中的价值、安全性及适应证。方法：回顾性分析2005年9月～2010年6月疑有小肠疾病的患者的资料，对经常规上、下消化道内镜检查均无异常发现的患者行DBE检查，并对其临床相关资料进行分析。结果：本研究共包括189 例，男127例，年龄15～86岁，平均47.3岁；女62例，年龄17～78岁，平均54.2岁。男女比为2.0:1。其中95例表现为不明原因反复发作的消化道出血，65例表现为腹痛、腹胀，29例表现为肠梗阻。共进行了202例次DBE检查，所有病例均成功插入小肠，检查成功率100%，平均检查时间为72.8分钟，其中经口检查60例，经肛检查116例，双侧对接检查13例。DBE 检查发现的小肠病变共143例，阳性率75.7%；5例病灶发生在常规上消化道内镜检查所能观察到的范围内。其中小肠炎症性改变50例（35.0%），血管发育不良36例（25.2%），小肠肿瘤30例（ 21.0%，良性18例，恶性12例），小肠息肉14例（9.8%），Peutz-Jeghers综合征4例（2.8%），Crohns病4例（2.8%）。小肠憩室4例（2.8%），小肠寄生虫1例（0.7%）。23例接受了镜下手术治疗（16.1%），包括内镜下止血及息肉切除，46例接受了外科手术治疗（32.2%）。12例检查过程中出现轻度黏膜擦伤或轻度自限性黏膜出血（8.4%），5例检查后出现咽部不适（3.5%），3例出现腹胀、腹痛（2.1%），1例出现肛门不适（0.7%），所有患者均无肠穿孔、胰腺炎等严重并发症发生。结论：DBE检查对小肠疾病具有较高的诊断价值，能够对整个小肠进行直视检查，检查成功率高，病变检出率高，而且安全、可靠。 　　关键词 双气囊小肠镜 小肠疾病 诊断 　　 　　AbstractObjective:To evaluate the diagnostic value、patientstolerance and complications of double-balloon enteroscopy（DBE）in the diagnosis of small intestinal diseases.Methods:The patients with suspected small intestinal diseases in our hospital from Sep 2005 to Jan 2009 were performed double-balloon enteroscopy（DBE）.Their data were analyzed.Results:98 patients （64 men,34 women） were studied，with a mean age of 55.7 years.51 patients presented with obscure recurrent gastrointestinal bleeding，34 patients presented abdominal pain，while 13 patients had small intestinal obstruction.A total of 115 DBEs were performed with a mean procedure duration of 72.8 minutes.Antegrade and retrograde approaches were performed in 35and 63 patients respectively,and 13 patients had a combination of both routes.The lesions were found in 74 of 98 patients with a total positive rate of 75.5%.5 lesions were found within the reach of a standard upper endoscope.31.1% patients had surgery procedures after DBE exam.The procedure was well tolerated，only 10（10.2%）patients experiencing mild self-limited mucosal bleeding during the procedure.Conclusions:DBE has a high diagnostic value in patients with previously negative u