电子结肠镜检查在儿童下消化道出血中的应用价值

Application value of colonoscopy in children with lower gastrointestinal bleeding

摘要:

目的 探讨电子结肠镜检查在儿童下消化道出血（LGIB）中的临床应用价值和胃镜替代电子结肠镜检查的可行性。方法 回顾性分析2017年1月－2020年3月该院消化内科收治的267例LGIB患儿的病历资料，对病因及电子结肠镜检查结果进行归纳总结。结果 学龄前儿童占69.29%。儿童LGIB的常见病因为肠道息肉、结直肠炎、炎症性肠病（IBD）、过敏性结肠炎、过敏性紫癜（HSP）和梅克尔憩室。其中，肠道息肉、IBD、嗜酸细胞性胃肠炎、过敏性结肠炎和白塞病的诊断阳性率达100.00%。通过内镜直视下局部止血治疗29例，镜下高频电凝电切治疗肠道息肉100例，均安全有效。267例患儿行电子结肠镜检查268例次，完成全结肠检查234例，总体盲肠插管率为87.31%。其中，电子结肠镜检查227例（盲肠插镜率为90.31%），胃镜代电子结肠镜检查41例（盲肠插镜率为70.73%）。结论 电子结肠镜检查在儿童LGIB诊疗中安全有效，不同病因导致的LGIB在电子结肠镜下表现不同，对于1岁以下或体重小于10 kg的患儿，采用胃镜替代电子结肠镜检查安全可行。

Abstract:

Objective To investigate the clinical application value of electronic colonoscopy in children with lower gastrointestinal bleeding and the feasibility of gastroscopy instead of colonoscopy.Methods A retrospective analysis of 267 cases of children with lower gastrointestinal bleeding from January 2017 to March 2020 was made, and the etiology and colonoscopy results were summarized.Results Preschool children account for 69.29%. The common non infectious diseases of lower gastrointestinal bleeding in children are intestinal polyps, colitis, inflammatory bowel disease, allergic colitis, allergic purpura and Meckel diverticulum. For intestinal polyps, IBD, eosinophilic gastroenteritis, allergic colitis and Behcet's disease, the positive rate was 100.00%. 29 cases were treated with endoscopic local hemostasis, and 100 cases of intestinal polyps were treated by high frequency electrocoagulation under endoscope. 267 children were examined by electronic colonoscopy 268 times, that total colonoscopy was performed in 234 cases. The total cecal intubation rate was 87.31%. Among them, 227 cases were examined by electronic colonoscopy (the cecal insertion rate was 90.31%), and 41cases were performed by gastroscopy instead of colonoscopy (the cecal insertion rate was 70.73%).Conclusion Electronic colonoscopy is safe and effective in the diagnosis and treatment of lower gastrointestinal bleeding in children,and different causes of gastrointestinal bleeding show different under colonoscopy, it is safe and feasible to use gastroscope instead of colonoscopy for children under 1 year old or with weight less than 10 kg.