双气囊小肠镜在小肠出血患者治疗中的应用价值及安全性研究

摘要

Objective To analyze the feasibility and the diagnostic yield of double-balloon enteroscopy (DBE) examinations for small bowel bleeding (SBB). Methods A retrospective analysis was conducted on 52 cases with small bowel bleeding between June 2015 and July 2016,and all was treated with DBE. therapeutic outcome, complications and follow-up were compared. Results The study included 52 patients (28 males and 24 females) with an average age of (51.0 ± 17.0) years (16~82 years) and onset time (8.3 ± 4.0) days (1~14 days) . 25 using oral route and 21 using the anal route, 1 using the colon ifstula route, a combination of using oral and anal (n=4).The bleeding source was identiifed in 40 of 52 patients (76.9%), complication rate was 5.8%(3/52), and rebleeding rate was 16.7%(2/12). The endoscopic treatments included polypectomies (n=5), argon plasma coagulation (APC, n=2), surgical treatment (n=14, 26.9%), and foreign-body extraction (n=1). Patients were diagnosed with the following:tumors (n=9, 17.3%), ulcers (n=9, 17.3%), Crohn’s disease (n=7, 13.5%), polyps (n=5, 9.6%), diverticulum (n=4, 7.7%). Patients with small bowel bleeding were followed up for a mean period of (8.3±2.0) months (range 4~10 months), 2 deaths were dying from small bowel cancer. Conclusions DBE is a safe endoscopic technique for patients with small bowel bleeding and can be safely carried out even after Roux-en-Y operation. Tumors, ulcers and Crohn’s disease are very common causes of SBB. The rebleeding rate after a negative DBE is considerable, especially small bowel vascular lesions.%目的：探讨双气囊小肠镜（DBE）在小肠出血（SBB）患者治疗中的应用价值及安全性，分析SBB患者的病因特点。方法收集2015年6月-2016年7月南京医科大学第二附属医院诊断为SBB的52例接受DBE检查的患者资料，回顾性分析诊治结果及并发症发生和随访情况。结果该研究共纳入患者52例（男28例，女24例），年龄16～82（51.0±17.0）岁，发病时间1～14（8.3±4.0）d。显性消化道出血37例，隐性消化道出血15例。经口进镜25例，经肛进镜21例，经结肠造瘘口进镜2例，口+肛4例。DBE的诊断率为76.9%（40/52），并发症发生率为5.8%（3/52），小肠镜检查阴性患者小肠再出血率16.7%（2/12）。5例小肠多发性息肉予以内镜黏膜切除术（EMR），2例小肠毛细血管扩张症给予氩离子凝固术（APC）。1例空肠癌伴胶囊滞留予以取出胶囊，14例（26.9%）接受手术治疗。SBB病因为肿瘤（n=9，17.3%）、溃疡（n=9，17.3%）、克罗恩病（n=7，13.5%）、息肉（n=5，9.6%），憩室/血管畸形（n=4，7.7%）等。SBB患者中位随访时间（8.3±2.0）个月，范围4～10个月，死亡2例，死因为小肠癌再出血。结论 DBE诊断SBB及行内镜下治疗安全有效，即使在困难病例Roux-en-Y术后。SBB病因以肿瘤、溃疡、克罗恩病较为常见，小肠镜检查阴性患者仍有小肠再出血可能，血管病变可能性大。