228例胶囊内镜检查的回顾分析

Retrospectively analysis of 228 capsule endoscopy examinations

摘要:

目的 探讨胶囊内镜（CE）在小肠克罗恩病（CD）检查中的应用、临床特点和并发症。 方法 分析228例CE检查的指征、诊断结果，比较CD与非CD的全小肠检查完成率和胶囊滞留率，完成全小肠检查者的小肠通过时间。 结果 共诊断CD 29例，占12.7%（29/228），其检查指征为，不明原因腹痛或（和）腹泻而怀疑CD者19例，不明原因消化道出血而怀疑CD者5例，CD治疗后复查5例。其CE表现包括：纵行溃疡（75.9%，22/29）或阿弗他溃疡（24.1%，7/29），节段性分布，假息肉样增生（37.9%，11/29），肠腔狭窄（34.5%，10/29）等。CD组全小肠检查完成率为62.1%（18/29），非CD组为82.4%（164/199），前者低于后者（P =0.023）。CD组的小肠通过时间为（4.35±1.83） h（n=18），非CD组为（4.54±1.86） h（n=164），差异无显著性（P =0.689）。CD组胶囊滞留率为13.8%（4/29），非CD组为1.0%（2/199），前者高于后者（P=0.003）。 结论 CD患者CE检查的完成率较低，胶囊滞留的风险较高，检查前应仔细询问病史、体格检查，配合腹部平片、小肠钡餐造影，甚至CT、MRI等检查，排除小肠狭窄、不全肠梗阻等，尽可能避免胶囊滞留。

Abstract:

【Objective】 To study the application, clinical characteristics and complications of capsule endoscopy (CE) in diagnosis of Crohn's disease (CD). 【Methods】 The indications and diagnosis of 228 CE examinations were retrospectively analyzed. The complete examination rate (CER), retention rate and small bowel transit time (SBTT) between CD patients and others were compared. 【Results】 Twenty nine (12.7%) CD were diagnosed and the indications were as follows: 19 patients suspected of having CD presented abdominal pain and/or diarrhea, 5 patients suspected of having CD presented obscure gastrointestinal bleeding (OGIB), 5 known CD for evaluation of curative effect after treatment. The CE findings of CD including longitudinal ulcers (75.9%, 22/29) or aphthous ulcer (24.1%, 7/29), cobblestone-like appearance (37.9%, 11/29), luminal stenosis (34.5%, 10/29). CER of CD group (62.1%, 18/29) was lower than that of other patients (82.4%, 164/199)(P =0.023). No statistical difference was found in SBTT between CD group (4.35±1.83) h, (n=18) and other patients (4.54±1.86) h, (n=164)(P =0.689). Retention rate in CD group (13.8%, 4/29) was higher than that in other patients (1.0%, 2/199)(P =0.003). 【Conclusion】 CER of Crohn's disease is low and retention rate of the disease is high. Obtaining a careful medical history, physical examination and imaging (plain abdominal X-ray, barium follow-through, CT, MRI) might contribute to avoid capsule retention in CD patients.