251例OMOM胶囊内镜临床应用研究

Clinical application of OMOM capsule endoscopy in 251 cases

摘要:

目的：探讨胶囊内镜（Capsule endoscopy，CE）在消化道疾病中的诊断价值，便于临床合理应用。方法：回顾性分析及电话随访251例CE检查者的临床资料。结果：老年人以不明原因消化道出血（Obscure gastrointestinal bleeding，OGIB）为检查原因的比例明显高于儿童、中青年（45.3% vs. 26.7%，P=0.005 7），而儿童、中青年以腹痛、腹泻为检查原因的比例明显高于老年人（71.1% vs. 54.7%，P=0.015 9）。完成全小肠检查率为93.2%。未完成全小肠检查组的胃运行时间与完成全小肠检查组比较有显著差异（66.2 min vs. 47.4 min，P=0.043 2），CE示胆汁反流为未完成全小肠检查的危险因素（OR=4.49）。肌注胃复安可以促进胶囊通过幽门，提高全小肠检查率（Complete rate，CR），而对小肠运行时间无明显影响（298.3 min vs. 313.3 min，P=0.561 3）。OGIB患者的小肠阳性诊断率为94.9%（75/79），以血管病变最常见（31.6%），其中高危人群小肠钩虫病占44.4%（8/18）；腹痛、腹泻患者的小肠阳性诊断率为85.7%（144/168），以黏膜炎症最常见（26.8%）。老年、儿童、青中年小肠阳性诊断率比较无显著差异（89.1% vs. 100% vs. 91.7%，P >0.05）。CE的阳性预测值为85.3%（29/34）。高清CE的小肠阳性诊断率明显高于06 CE（96.7% vs. 86.4%，P=0.032 3）。所有受检者耐受性良好，胶囊均顺利排出。结论：CE检查操作简单、安全、有效，对小肠疾病的诊断有重要价值。肌注胃复安可提高全小肠检查率。钩虫高危人群行CE检查前可诊断性驱虫。

Abstract:

Objective：To investigate the diagnostic value of capsule endoscopy（CE） in patients with gastrointestinal diseases and to guide the reasonable application of capsule endoscopy. Methods：The clinical data of 251 patients underwent OMOM capsule en－doscopy with telephone follow-ups were retrospectively analyzed. Results：There were significant differences in the patients with ob－scure gastrointestinal bleeding between the elderly group and the non-elderly group（45.3% vs. 26.7%，P=0.005 7）. Meanwhile，there were significant differences in the patients with abdominal pain or diarrhea between the elderly group and the non-elderly group （54.7% vs. 71.1%，P=0.015 9）. The rate of complete small-bowel examination was 93.2%. The gastric transit time in complete small-bowel examination was significantly shorter than that in the non-complete small-bowel examination group（47.4 min vs. 66.2 min，P=0.043 2）. CE showed that the risk of non-complete small-bowel examination was bile reflux（OR=4.49）. Metoclopramide（10 mg，intramuscular injection） did not exerted effect on the small bowel transit time（298.3 min vs. 313.3 min），but it can reduce the gas－tric transit time of the capsule. The positive detection rate of small bowel diseases was up to 94.9% in the patients with obscure gas－trointestinal bleeding（75/79），most commonly in vascular malformation（31.6%）. The positive detection rate was 44.4%（8/18） for high risk population of small intestine ancylostomiasis；85.7%（144/168）for abdominal pain or diarrhea group with mucosal inflammation was frequent seen（26.8%）. There were no significant differences in the detection rate of small bowel diseases among the elderly group，the children group and the middle-aged group（89.1% vs. 100% vs. 91.7%）. The detection rate of small bowel diseases was significantly higher in the high definition capsule endoscopy group than that in the 06 capsule endoscopy group（96.7% vs. 86.4%，P=0.032 3）. All patients were well tolerated and the capsule and successfully discharged. Conclusion：The manipulation of capsule endoscopy is simple，safe and effective and it is of important value in the diagnosis of small intestinal diseases. Metoclopramide （intramuscular in－jection） can improve the complete rate. Parasite elimination can be done before CE exam for high risk population of small intestine ancylostomiasis.