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

Application and safety of double balloon enteroscopy in patients with small bowel hemorrhage

摘要:

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。

Abstract:

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 fistula route, a combination of using oral and anal (n = 4).The bleeding source was identified 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.