内镜检查在儿童慢性腹泻诊断中的应用价值

The value of endoscopy in the diagnosis of chronic diarrhea in children

摘要:

目的 探讨内镜检查技术对于儿童慢性腹泻的病因诊断价值，以期为临床早期识别与治疗提供参考依据。方法 回顾性分析2017年1月－2024年6月于该院消化内科住院的130例慢性腹泻患儿的病例临床资料，归纳总结其病因构成、电子胃肠镜、黏膜活组织检查和胶囊内镜的检查结果。结果 130例患儿均完成电子胃肠镜或胶囊内镜检查，总体病变检出率为93.1%。73例患儿接受了电子胃镜检查，65例发现异常，病变检出率为89.0%。7例患儿行胶囊内镜检查，5例发现黏膜病变。125例患儿完成电子结肠镜检查，94例存在黏膜异常，检出率为75.2%。90例患儿接受了结肠黏膜病理学检查，主要病理改变：黏膜炎症38例（42.2%），肠黏膜糜烂10例（11.1%），淋巴滤泡增生14例（15.6%），嗜酸性粒细胞浸润3例（3.3%），炎症性肠病改变10例（11.1%），慢性活动性炎伴隐窝炎或隐窝脓肿14例（15.6%），以及幼年性息肉1例（1.1%）。结论 儿童慢性腹泻病因多样，内镜检查结合黏膜病理学检查是明确诊断的关键手段，尤其对于炎症性肠病和过敏性肠炎等具有重要意义。建议在严格把握适应证的前提下，积极推广儿童消化内镜技术的临床应用，并重视多部位活检与胶囊内镜的合理运用。

Abstract:

Objective To investigate the diagnostic value of endoscopy in pediatric chronic diarrhea and provide evidence for early diagnosis and treatment.Methods Clinical data from 130 pediatric patients hospitalized in the Department of Gastroenterology in our hospital between January 2017 and June 2024 were analyzed. Etiologies and findings were summarized from electronic gastroscopy/colonoscopy, mucosal biopsy, and capsule endoscopy.Results All 130 children completed electronic gastroenteroscopy or capsule endoscopy examinations,the overall lesion detection rate was 93.1%. Electronic gastroscopy was performed in 73 cases, revealing lesions in 65 cases (detection rate: 89.0%). Capsule endoscopy was conducted in 7 cases, with mucosal lesions detected in 5 cases. Of the 125 patients who underwent electronic colonoscopy, mucosal lesions were detected in 94 cases, yielding a detection rate of 75.2%. Pathological examination of colonic specimens was performed in 90 cases. Primary pathological findings included-mucosal inflammation was in 38 cases (42.2%), intestinal mucosal erosion was in 10 cases (11.1%), lymphoid follicular hyperplasia was in 14 cases (15.6%), eosinophilic infiltration was in 3 cases (3.3%), features suggestive of inflammatory bowel disease were in 10 cases (11.1%),chronic active inflammation with cryptitis/ crypt abscesses was in 14 cases (15.6%) and one case of juvenile polyp (1.1%).Conclusion The etiology of chronic diarrhea in children is complex. Combining endoscopy with mucosal pathology aids in definitive diagnosis, particularly for inflammatory bowel disease and allergic enteritis. It is recommended to actively promote the application of pediatric digestive endoscopy technology based on strict adherence to indications, with particular emphasis on multi-site biopsies and the rational use of capsule endoscopy.