CT小肠成像与双气囊小肠镜在疑似小肠出血诊断中的临床应用

刁磊; 洪汝涛; 韩玮; 胡静; 陈熙

doi:10.16766/j.cnki.issn.1674-4152.002057

CT小肠成像与双气囊小肠镜在疑似小肠出血诊断中的临床应用

doi: 10.16766/j.cnki.issn.1674-4152.002057

安徽医科大学第一附属医院消化内科，安徽合肥 230022

基金项目:

2019年安徽省重点研究与开发计划项目 201904a07020043

详细信息

通讯作者:
陈熙，E-mail：ayfychenxi@163.com

中图分类号: R574.5 R445.3
计量
- 文章访问数: 89
- HTML全文浏览量: 76
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2020-12-28
- 网络出版日期: 2022-02-16

Clinical application of CT enterography and double-balloon enteroscopy in the diagnosis of suspected small intestinal bleeding

Department of Gastroenterology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China

摘要

摘要: 目的通过对疑似小肠出血患者的临床资料进行回顾性分析，探讨CT小肠成像(CTE)与双气囊小肠镜(DBE)在疑似小肠出血诊断中的应用价值。方法回顾性分析2019年10月—2020年10月于安徽医科大学第一附属医院消化内科住院的54例疑似小肠出血患者的临床资料，统计CTE及DBE对疑似小肠出血诊断的阳性结果及并发症发生例数，采用χ²检验或Fisher精确检验对数据进行统计，比较CTE及DBE对小肠出血的诊断率及并发症发生率，探讨CTE及DBE对疑似小肠出血的诊断价值及安全性。结果 54例疑似小肠出血患者均顺利完成CTE及DBE检查，2种检查方式成功率均为100%，病灶主要包括憩室、溃疡、血管扩张性病变、肿瘤及克罗恩病。CTE对病灶诊断率为53.7%(29/54)，DBE对病灶诊断率为79.6%(43/54)，2组比较差异有统计学意义(χ²=8.167，P＜0.01)。在安全性方面，所有患者行CTE检查未出现并发症，54例行DBE检查患者仅1例出现并发症，并发症发生率为1.9%(1/54)，2组比较差异无统计学意义(P＞0.05)。结论 DBE对小肠出血的诊断率明显高于CTE且无严重并发症发生，CTE对溃疡及血管扩张性病变的诊断率不高，但对憩室、肿瘤性病变及克罗恩病敏感性较高，临床工作中应结合CTE及DBE检查结果，以免造成疾病的漏诊及误诊。
- CT小肠成像 /
- 双气囊小肠镜 /
- 小肠出血
Abstract: Objective The clinical data of patients with suspected small bowel bleeding in our hospital were analyzed retrospectively to explore the application value of CT enterography (CTE) and double-balloon enteroscopy (DBE) in the diagnosis of suspected small bowel bleeding. Methods The clinical data of 54 patients with suspected small bowel bleeding hospitalized in the Department of Gastroenterology of the First Affiliated Hospital of Anhui Medical University from October 2019 to October 2020 were analyzed retrospectively. The positive results of CTE and DBE in the diagnosis of suspected small bowel bleeding and the cases of complications were counted. The results were counted by the 2 test or exact probability method of Fisher test. The diagnostic rate and complication rate of intestinal hemorrhage were compared by CTE and DBE, and the diagnostic value and safety of CTE and DBE were discussed. Results All the 54 patients completed CTE and DBE examination, with a success rate of 100%. The lesions mainly included diverticulum, ulcer, vasodilation, tumor and Crohn's disease. The diagnosis rate of lesions by CTE was 53.7% (29/54) compared with 79.6% (43/54) by DBE and the difference was significant (χ²=8.167, P < 0.01). In terms of safety comparison, there was no complications in all patients who underwent CTE examination (0/54). However, the incidence of complications in 54 patients examined by DBE was only 1 case, and the incidence of complications was 1.9% (1/54). No significant difference was observed in the incidence of complications between CTE and DBE (P>0.05). Conclusion The diagnostic rate of DBE in small bowel bleeding is significantly higher than that of CTE, and without serious complications. The diagnostic rate of CTE for ulcer and vasodilation is not high, but it is sensitive to diverticulum, tumor and Crohn's disease. CTE combined with DBE examination can effectively avoid missed diagnosis of small bowel bleeding.
- Computed tomography enterograhy /
- Double balloon enteroscopy /
- Small bowel bleeding

HTML全文

图 1 内镜下阴性，小肠CT诊断间质瘤1例

注：A为经口小肠镜见空回肠黏膜散在血管显露，未见溃疡及占位性病灶；B为小肠CT见近段空肠类圆形软组织密度影，跨腔内外生长，其内密度欠均匀，局部以宽基底与肠壁相连(矢状位)；C为小肠CT见近段空肠类圆形软组织密度影(横断位)。

下载: 全尺寸图片幻灯片

表 1 CTE及DBE对病灶检出情况(例)

病灶类型	CTE检查	DBE检查
小肠病变	29	41
憩室	10	14
溃疡	0	11
血管扩张性病变	2	4
肿瘤性病变	7	3
克罗恩病	8	3
胆肠吻合口出血	0	2
黏膜下隆起	0	2
血管瘤	0	1
肠套叠	1	0
血吸虫病	1	0
息肉	0	1
非小肠病变	0	2
结肠血管扩张性病变	0	1
胃窦毛细血管扩张	0	1
阴性	25	11

下载: 导出CSV

表 2 CTE与DBE对病灶诊断率及安全性比较[例(%)]

检查方式	阳性	并发症
CTE	29(53.7)	0(0.0)
DBE	43(79.6)	1(1.9)
χ²值	8.167
P值	0.004	0.999^a
注：^a为采用Fisher精确检验。

下载: 导出CSV

参考文献(17)

[1]	ZAMMIT S C, SIDHU R. Small bowel bleeding: Cause and the role of endoscopy and medical therapy[J]. Curr Opin Gastroenterol, 2018, 34(3): 165-174. doi: 10.1097/MOG.0000000000000429
[2]	ASGE STANDARDS OF PRACTICE COMMITTEE. The role of endoscopy in the management of suspected small-bowelbleeding[J]. Gastrointest Endosc, 2017, 85(1): 22-31. doi: 10.1016/j.gie.2016.06.013
[3]	OHMIYA N. Management of obscure gastrointestinal bleeding: Comparison of guidelines between Japan and other countries[J]. Dig Endosc, 2020, 32(2): 204-218. doi: 10.1111/den.13554
[4]	KUO J R, PASHA S F, LEIGHTON J A. The clinician's guide to suspected small bowel bleeding[J]. Am J Gastroenterol, 2019, 114(4): 591-598. doi: 10.1038/s41395-018-0424-x
[5]	占俊, 汤进芝, 汪文生, 等. 不同剂型聚乙二醇电解质在结肠镜检查前肠道准备中的应用比较[J]. 中华全科医学, 2020, 18(8): 1283-1286. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202008011.htm
[6]	KUSHNIR V M, TANG M, GOODWIN J, et al. Long-term outcomes after single-balloon enteroscopy in patients with obscure gastrointestinal bleeding [J]. Dig Dis Sci, 2013, 58(9): 2572-2579. doi: 10.1007/s10620-013-2588-y
[7]	OTANI K, WATANABE T, SHIMADA S, et al. Clinical utility of capsule endoscopy and double-balloon enteroscopy in the management of obscure gastrointestinal bleeding[J]. Digestion, 2018, 97(1): 52-58. doi: 10.1159/000484218
[8]	GERSON L B. Small bowel bleeding: Updated algorithm andoutcomes[J]. Gastrointest Endosc Clin N Am, 2017, 27(1): 171-180. doi: 10.1016/j.giec.2016.08.010
[9]	HASHIMOTO R, NAKAHORI M, MATSUDA T. Impact of urgent double-balloon enteroscopy on the short-term and long-term outcomes in overt small bowel bleeding[J]. Dig Dis Sci, 2019, 64(10): 2933-2938. doi: 10.1007/s10620-019-05627-1
[10]	SONG J H, HONG S N, CHANG D K, et al. The etiology of potential small-bowel bleeding depending on patient's age and gender[J]. United European Gastroenterol J, 2018, 6(8): 1169-1178. doi: 10.1177/2050640618797841
[11]	曹皓阳, 高青. 原发性小肠淋巴瘤诊治研究进展[J]. 现代医药卫生, 2020, 36(14): 2202-2205. https://www.cnki.com.cn/Article/CJFDTOTAL-XYWS202014022.htm
[12]	DEEPAK P, PUNDI K N, BRUINING D H, et al. Multiphase computed tomographic enterography: Diagnostic yield and efficacy in patients with suspected small bowel bleeding[J]. Mayo Clin Proc Innov Qual Outcomes, 2019, 3(4): 438-447. doi: 10.1016/j.mayocpiqo.2019.09.001
[13]	HE B, YANG J, XIAO J, et al. Accuracy of computed tomographic enterography for obscure gastrointestinal bleeding: A diagnostic meta-analysis[J]. Acad Radiol, 2018, 25(2): 196-201. doi: 10.1016/j.acra.2017.09.001
[14]	中华消化杂志编辑委员会. 小肠出血诊治专家共识意见[J]. 中华消化杂志, 2018, 38(9): 577-582. doi: 10.3760/cma.j.issn.0254-1432.2018.09.001
[15]	郭志国, 彭炤源, 辛毅, 等. 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[J]. 中国内镜杂志, 2017, 23(1): 103-106. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGNJ201701022.htm
[16]	HASHIMOTO R, MATSUDA T, NAKAHORI M. False-negative double-balloon enteroscopy in overt small bowel bleeding: Long-term follow-up after negative results[J]. Surg Endosc, 2019, 33(8): 2635-2641. doi: 10.1007/s00464-018-6561-x
[17]	YIN A, ZHAO L, DING Y, et al. Emergent double balloon enteroscopy in overt suspected small bowel bleeding: Diagnosis and therapy[J]. Med Sci Monit, 2020, 26: e920555. http://www.researchgate.net/publication/338755087_Emergent_Double_Balloon_Enteroscopy_in_Overt_Suspected_Small_Bowel_Bleeding_Diagnosis_and_Therapy