多层螺旋CT小肠造影与双气囊小肠内镜判断小肠克罗恩病活动度的价值

目的研究多层螺旋CT小肠造影(MSCTE)和双气囊小肠内镜(DBE)在小肠克罗恩病(CD)的诊断和判断其活动度的价值。方法选取经临床确诊的32例小肠CD患者,分别进行MSCTE检查和DBE检查并作出诊断和分析,比较两种方法在诊断小肠CD,判断病变位置、范围、活动度和并发症方面的能力。结果 MSCTE与DBE对小肠CD确诊率相似,两者比较,差异无统计学意义(P0.05)。对于显示并发症的能力,MSCTE明显优于DBE。结论 MSCTE是诊断小肠CD的首选辅助检查,能判断炎症是否处于活动期及发现肠腔外并发症,而且能指导DBE的进镜方式,与DBE联合应用有利于诊断和评价小肠CD患者的炎症活动度,指导临床治疗。     

胶囊内镜配合多层螺旋CT小肠造影在小肠血管畸形诊断中的应用价值

目的研究胶囊内镜（CE）和多层螺旋CT小肠造影（MSCTE）在小肠血管畸形（vascular malformation,VM）诊断中的价值。方法对36例临床疑似小肠VM患者分别进行CE和MSCTE检查并做出诊断,结合术后病理及临床随访结果,比较两种方法在小肠VM诊断,判断病变范围及并发症等方面的情况。结果 CE与MSCTE对小肠VM确认率相似,两者间差异无统计学意义（χ2=2.29,P〉0.05）。两种检查方法对Ⅲ型和Ⅳ型血管VM判断的一致性明显高于对Ⅰ型和Ⅱ型的VM（χ2=11.298,P=0.001）。CE和MSCTE对疾病范围判断的一致性为95.2%。结论 CE可能是确诊小肠VM的首选方法,与MSCTE联合应用有利于诊断和评价小肠VM患者的病情。     

双气囊内镜与多层螺旋CT小肠造影在小肠克罗恩病诊断中的作用

Objective To investigate the value of double-balloon endoscopy (DBE) and multi-slice CT enteroclysis (MSCTE) in diagnosis of Crohn's disease (CD) in small intestine. Methods DBE and MSCTE were performed in 71 patients with suspected Crohn's disease in small intestine. The two methods were compared in terms of diagnosis, extents of disease, existance of complications and activity of the disease according to the pathologic findings and the outcome of follow-up. Results The diagnostic yields of DBE and MSCTE were comparable with no significant difference (χ2=2.29, P> 0.05). The positive and negative likelihood ratios were 22.5 and 0. 022 in DBE respectively, and were 1.6 and 0. 240 in MSCTE respectively. The results of DBE was consistent with MSCTE in diagnosis of mild bowel stenosis, but was inconsistent with MSCTE in diagnosis of moderate-severe bowel stenosis (χ2=11.298, P=0.001). The concordance of two methods in diagnosis of disease activity was 95.8%. Conclusions The first choice in diagnosis of small bowel CD is DBE. The combination of two methods will be helpful in diagnosis and evaluation of CD severity.     

双气囊小肠镜与小肠CT诊断小肠疾病的临床分析

[目的]比较双气囊小肠镜(DBE)与小肠计算机断层摄像扫描(MDCTE)在小肠疾病的确诊率、阳性检出率和实用价值。[方法]回顾分析2014~2016年的100例患者的临床资料,所有入院患者均接受了MDCTE和DBE检查,DBE首选进镜方式分为经口或经肛2种,首选方式检查后未发现病灶者,随即改换进镜方式再行检查。2种检查方式分别由2名不同的专门医师独立操作并诊断,最后进行汇总比较分析。[结果]不管在阳性检出率还是在确诊率,DBE均高于MDCTE,不同适应证的阳性检出率分别为53.0%和78.0%(P=0.317);而确诊率分别为41.0%和83.0%(P=0.291)。在血管畸形和炎症性肠病的确诊方面,MDCTE和DBE的差异有统计学意义(P0.05);而在小肠新生物和肠梗阻的确诊方面,差异无统计学意义(P=1)。[结论]1DBE和MDCTE均能完成对全小肠的检查;2DBE较MDCTE而言,阳性检出率和确诊率均较高,是诊断和治疗小肠疾病的有效诊治手段。但MDCTE有无创、快速采集,扫描范围大、高空间分辨率、图像后处理技术以及同时观察肠壁及肠腔内外的优点。     

多排螺旋计算机断层成像技术小肠造影对小肠疾病的诊断价值

目的评价多排螺旋计算机断层成像技术小肠造影（MSCTE）对诊断小肠疾病的诊断价值。方法98例疑为小肠病变的患者行MSCTE检查，观察受试者对MSCTE的耐受性以及有无并发症，观察分析不同病变的MSCTE表现，并以手术病理结果或小肠捕管造影、内镜和（或）活检病理的综合诊断结果为金标准来判断MSCTE对小肠病变的诊断价值。结果所有受试者均顺利完成MSCTE，未发现并发症。其中2例为小肠捕管造影失败而改行MSCTE。MSCTE诊断小肠病变总的灵敏度为96．5％（83／86），MSCTE结果与最后临床诊断符合率为90．8％（89／98）。结论MSCTE是一种简便易行、能多方位、全景式显示小肠的方法，对多种小肠疾病有较高的诊断价值。     

双气囊内镜对小肠狭窄性疾病诊断和治疗选择的价值

目的 探讨双气囊内镜(DBE)对小肠狭窄性病变尤其是肿瘤的诊断和治疗方法选择的价值.方法 2003年6月至2006年7月在广州南方医院对208例可疑小肠疾病患者行DBE检查,发现病变进行活检、标记,并与部分手术结果对照.结果 208例可疑小肠疾病患者中DBE检查发现小肠狭窄39例,检出率18.8%.DBE诊断小肠肿瘤14例,多发性溃疡(含克罗恩病)18例,回肠憩室5例,炎性狭窄或外压2例,其中手术治疗19例,证实18例.39例患者临床表现主要以单纯或合并不全性肠梗阻、黑便为主,其中无肠梗阻表现的占59.0%(23/39).结论 DBE对小肠狭窄尤其是肿瘤性小肠狭窄有较高的检出率和诊断率;对于治疗方式选择,小肠肿瘤性狭窄需选择剖腹手术,在缺乏相应的DBE治疗器械的情况下,良性肿瘤或良性病变可选择腹腔镜手术.     

多层CT小肠造影与单气囊小肠镜对小肠梗阻的诊断价值

目的探讨多层CT小肠造影(MSCTE)与单气囊小肠镜(SBE)在小肠梗阻性病变的诊断价值。方法收集2009年6月-2013年2月临床和/或腹部X线平片疑为小肠梗阻的患者30例。所有患者先行MSCTE检查,根据检查结果选择经口或经肛SBE检查。分析两种检查方法对小肠梗阻性病变的诊断率。结果①MSCTE检查诊断小肠梗阻的灵敏度为85.19%,特异度为66.67%,阳性预测值为95.83%,阴性预测值为33.33%。SBE检查分别为81.48%、100%、100%和37.50%。②MSCTE和SBE检出病变一致性为53.33%(16/30)。③根据MSCTE检查结果选择经口或经肛SBE检查,MSCTE检查阳性指导SBE选择进镜方式正确率高于MSCTE检查阴性(95.83%vs33.33%,P<0.05)。结论 MSCTE和SBE对小肠梗阻的诊断率相当,二者联合应用可提高对小肠梗阻性病变的诊断率。MSCTE检查结果可以指导SBE选择进镜方式。     

双气囊电子内镜在消化系统疾病中的诊断价值

目的 探讨双气囊电子内镜(DBE)在消化系统(尤其是小肠)疾病中的诊断价值.方法 对我院50例DBE检查患者进行临床分析和电话随访.结果 50例患者共行65次DBE检查.在所有患者、不明原因消化道出血(OGIB)和腹痛或腹部不适患者中,确诊率分别为84.0%、84.0%和88.2%;DBE检查准确率为90.5%、90.5%和86.7%.对小肠病变的诊断敏感性为94.1%、94.4%和90.0%;特异性为75.0%、66.7%和80.0%;阳性预测值为94.1%、94.4%和90.0%;阴性预测值为75.0%、66.7%和80.0%.不同DBE检查时机患者之间的确诊率(92.3%:75.0%)和DBE检查准确率(91.7%:88.9%)均无显著性差异(P>0.05).结论 DBE对小肠疾病具有较好的诊断价值,不同指征患者之间存在差异.DBE检查时机对OGIB的诊断能力无明显影响.     

双气囊内镜检查对小肠溃疡病变的诊断研究

目的 研究双气囊内镜(DBE)检查对小肠溃疡病变的诊断价值.方法 统计2003年9月到2007年12月广州南方医院DBE检查发现的小肠单纯溃疡而内镜活检显示为"小肠溃疡"或"慢性炎症"者的资料.结果 符合以上条件者62例,其中男48例,女14例,年龄10～71岁,平均43.9岁.临床主诉为消化道出血38例(61.3%)、腹痛16例(25.8%)、腹胀5例(8.1%)、消瘦2例(3.2%)、腹泻1例(1.6%).DBE诊断为克罗恩病53例(85.5%)、药物性溃疡4例(6.5%)、慢性非特异性炎症2例(3.2%)、淋巴瘤2例(3.2%)、结核1例(1.6%).62例内镜活检常规病理全部为"慢性炎症".其中32例行手术治疗(51.6%),在DBE诊断为克罗恩病的30例中,手术后诊断为克罗恩病22例(3例合并癌变)、淋巴瘤4例、白塞病3例、小肠结核1例,DBE确诊率73.3%;DBE诊断的1例小肠结核和1例淋巴瘤,手术后诊断均为克罗恩病.62例小肠溃疡病变DBE总的确诊率为68.8%(22/32),误诊率达31.2%(10/32).结论 对小肠溃疡病变的定性诊断,DBE结合常规活检也不是特异的,常规病理结合免疫组化技术有可能提高诊断的准确率,当内科治疗效果不好时,适时外科手术对其诊断和治疗都是有益的.     

115例疑似小肠疾病患者双气囊小肠镜检查结果分析

目的分析双气囊小肠镜(DBE)检查阴性患者的临床特点。方法对武汉大学人民医院消化科2005年12月至2009年7月怀疑小肠疾病的115例患者行DBE检查。其中DBE检查阴性和阳性患者分别为32例和83例,比较两组患者的临床资料。结果 115例患者中检出的小肠病变为83例,总诊断率为72.2%,共2例并发急性胰腺炎,1例发生高淀粉酶血症。DBE检查阴性患者的初始血红蛋白比阳性患者高[(107.938±26.015)g/L对(93.518±32.367)g/L,P=0.016],同时二者在临床症状(不明原因消化道出血、不明原因不全肠梗阻、腹痛待查、腹泻待查)的比较也有统计学意义(12∶6∶11∶3对54∶12∶15∶2,P=0.035)。且其对不明原因消化道出血的阳性检出率(81.8%)明显高于腹痛待查(57.7%)和腹泻待查(40%)患者的检出率。结论 DBE是目前诊断小肠疾病的有效方法 ,然而对于初始血红蛋白较高或以腹痛、腹泻症状为主的患者应慎重选择此检查方法 。     

Clinical utility of a new endoscopic scoring system for Crohn's disease

AIM:To evaluate the clinical value of the newly modified Simple Endoscopic Score for Crohn's disease(m SES-CD).METHODS:Seventy-six Crohn's disease(CD) patients who underwent transanal double balloon endoscopy(DBE) in our hospital between 2003 and 2012 were retrospectively reviewed. DBE is defined as small intestinal endoscopy using two attached balloons. We included patients with stenosis which hampered passage of the scope and those who underwent DBE with observation for at least 80 cm from the ileocecal valve. Our new m SES-CD assesses the endoscopic activity of two consecutive small intestinal segments located 0-40 cm and 40-80 cm from the ileocecal valve by DBE,in addition to the activity of four colorectal segments. To compare the usefulness of m SES-CD with SES-CD,we similarly divided the patients into two groups according to total m SES-CD score(low disease activity group, 4; high disease activity group,≥ 4). The clinical value of m SES-CD in predicting clinical outcome in patients with CD was evaluated using the occurrence of surgery after DBE as an endpoint.RESULTS:Median age of the 76 CD patients was 36 years(range,16-71). Thirty-nine patients had stenosis which hampered passage of the DBE to 80 cm on the proximal side from the ileocecal valve. Median evaluable length of small intestine by DBE was 80 cm(range,3-200). A total of 74 patients had one or more small intestinal lesions detected by DBE,of which 62(83.8%) were within 80 cm of the ileocecal valve on the proximal side. Only two patients(2.7%) with proximal-side lesions more than 80 cm from the ileocecal valve did not have lesions within 80 cm. Patients with high m SES-CD scores showed significantly shorter surgeryfree survival than those with low scores(P 0.05). In contrast,surgery-free survival did not significantly differ between the low and high SES-CD groups(P 0.05). Multivariate analysis by a Cox proportional hazards model identified m SES-CD as an independent factor for surgery-free survival.CONCLUSION:m SES-CD is useful in evaluating the risk of surgery-free survival in patients with CD.     

多层螺旋CT小肠增强造影在诊断炎症性肠病中的价值研究

目的评估多层螺旋CT小肠增强造影（MSCTE）在诊断炎症性肠病（IBD）中的价值。方法回顾性分析45例IBD患者的病史资料,总结其MSCTE的影像学表现特点,并与常规结肠镜检查结果进行对比分析。结果 45例IBD患者中克罗恩病（CD）29例,溃疡性结肠炎（UC）16例。CD患者中,25例MSCTE有阳性发现,最常见的为肠道管壁增厚（21例,72.4%）及肠周间隙模糊伴渗出（9例,31.0%）;发现病变的部位以回盲部及末端回肠最多（44.8%）;MSCTE表现与结肠镜检查结果对比,前者发现的病变部位与后者完全吻合的有15例（51.7%）,前者发现空肠病变部位而后者无法发现的有10例（34.5%）。UC患者中,只有6例MSCTE有阳性发现,其中肠道管壁增厚亦最多见（5例,31.3%）;发现病变的部位以结肠居多（31.3%）;MSCTE表现与结肠镜检查结果对比,前者发现的病变部位与后者完全吻合的只有5例（31.3%）,而后者发现病变部位而前者未发现的却有11例（68.7%）。结论多层螺旋CT小肠增强造影对于CD的诊断价值较高。可通过发现小肠可能的病灶来弥补常规结肠镜检查的不足。MSCTE对于UC的诊断价值有限。     

Evaluation of deep small bowel involvement by double-balloon enteroscopy in Crohn's disease

OBJECTIVES: Double-balloon enteroscopy (DBE) enables inspection of deep small bowel, and total small bowel examination can be performed by either antegrade or retrograde DBE. The aim of this study was to evaluate ileal involvement, which cannot be achieved using conventional colonoscopy, by DBE in patients with Crohn's disease. METHODS: From December 2003 to September 2005, a total of 44 patients with Crohn's disease underwent 53 examinations using DBE. RESULTS: Forty patients with Crohn's disease, seven women and 33 men, underwent DBE, and the ileum was investigated in 38 patients. There were 25 cases of ileitis, 2 of colitis, and 13 of ileocolitis. Jejunal lesions were found in two and ileal lesions proximal to the terminal ileum were found in 24 patients with Crohn's disease. DBE was superior to radiological study to detect aphthae, erosions, and small ulcers in the ileum. Small bowel stricture was demonstrated in six and nine patients with DBE and small bowel barium study (SBBS), respectively. An additional mucosal finding was demonstrated in one of the eight patients who underwent wireless capsule endoscopy, and one patient had a capsule removed by DBE that had become lodged because of an ileal stricture. One ileal perforation because of overtube balloon pressure occurred in 53 examinations of patients with Crohn's disease (1.9%). CONCLUSION: DBE is useful to evaluate small bowel lesions in patients with Crohn's disease; however, special attention should be paid to mesenteric longitudinal ulcers during insertion and the overtube balloon should not be inflated if a clear intestinal view is not possible.     

双气囊内镜检查对小肠疾病的诊断价值

目的探讨小肠溃疡性病变的临床、内镜、病理等特点。方法临床怀疑小肠疾病者155例。按术者操作内镜并送镜,助手辅助进外套管的方法。结果155例患者中,125例发现病变,阳性率80．6％。检出的主要疾病为小肠溃疡（含克罗恩病）、慢性炎症、美克尔憩室、间质瘤、血管畸形、小肠癌等。其中92例怀疑小肠出血者,检查阳性84例（91．3％）;39例腹痛患者中,阳性24例（61．5％）;腹泻、腹胀、消瘦23例,阳性16例（69．6％）。病变位于胃及十二指肠9例,小肠病变115例,大肠病变1例,全消化道未发现病变30例。在155例接受双气囊内镜（DBE）检查的患者中,检出小肠溃疡性病变43例;病灶数为单个12例,多个（2个及以上）31例;病变位于空肠的18例,回肠20例,空肠和回肠都有病变的5例。DBE结合组织学检查对美克尔憩室、间质瘤、癌、血管病变、肠黏连的诊断与手术后诊断是完全相符的;而对溃疡性病变（主要是克罗恩病）的诊断与手术后诊断却相差较大,符合率57．1％（4／7）。发生小肠穿孔和急性肠梗阻并发症各1例。结论DBE目前是诊断小肠疾病安全、有效的方法,特别在发现病变方面,但对溃疡性病变的定性即使结合活检也未必是特异的,及时行外科处理对某些溃疡性病变的诊断和治疗都是有益的。     

Double-balloon enteroscopy versus magnetic resonance enteroclysis in diagnosing suspected small-bowel Crohn's disease: results of a pilot study

OBJECTIVE: Small-bowel manifestations are common complications in Crohn's disease (CD) but can often be underestimated because of diagnostic limitations. Double-balloon enteroscopy (DBE) is a new endoscopic method that provides complete visualization and biopsy sampling of the small bowel with potential implications for diagnosis and therapy. The purpose of this study was to compare the diagnostic yield of DBE and magnetic resonance enteroclysis (MRE) in patients suspected of having small-bowel CD. MATERIAL AND METHODS: Ten patients were consecutively selected and included in the study. In all patients a DBE of the small bowel was performed, the endoscopist being unaware of the radiological findings. Evaluation criteria included the presence of pathology, localization, degree, and extension of affection according to predefined morphologic criteria. Samples for histopathological investigation were taken in all patients with abnormal mucosa. RESULTS: In 50% of the patients (5 out of 10) with suspected small-bowel CD, DBE revealed pathological results. Here, in four patients, CD was verified histologically. A new diagnosis had to be established in one patient diagnosed for malignant lymphoma. The medical management had to change in five patients. In two patients, both DBE and MRE showed no pathological results; in three patients, superficial lesions were identified by MRE, whereas DBE was normal. CONCLUSIONS: In selected patients with suspected small-bowel lesions, DBE is a promising tool in the diagnostic work-up and provides the advantage of biopsy sampling. In contrast, non-invasive MRE delivers excellent information about extraluminal pathology associated with CD. Both MRE and DBE have the potential to become diagnostic standards that complement each other in patients with suspected complex small-bowel CD.     

A case of small bowel adenocarcinoma in a patient with Crohn's disease detected by PET/CT and double-balloon enteroscopy

Small bowel adenocarcinoma (SBA) in patients with Crohn's disease (CD) is quite rare, difficult to diagnose without surgery, and has a poor prognosis. Here, we report a 48-year-old man with SBA and a 21-year history of CD who was diagnosed by a combination of positron emission tomography/computed tomography (PET/CT) and double-balloon enteroscopy (DBE). Since the age of 27 years, the patient had been treated for ileal CD and was referred to our hospital with persistent melena. Multiple hepatic tumors were found by CT. PET/CT detected an accumulation spot in the small bowel. DBE revealed an ulcerative tumor in the ileum about 100 cm from the ileocecal valve. An endoscopic forceps biopsy specimen showed poorly differentiated adenocarcinoma. There were some longitudinal ulcer scars near the tumor, and the chronic inflammation in the small bowel appeared to be associated with the cancer development. Previous reports suggest the risk of SBA in patients with CD is higher than in the overall population. Since early diagnosis is extremely difficult in these cases, novel techniques, such as PET/CT and DBE, may be expected to help in making a preoperative diagnosis of the development of SBA in CD.     

双气囊内镜和胶囊内镜诊断小肠出血的临床评价

目的评价双气囊内镜和胶囊内镜对小肠出血的临床诊断价值。方法比较双气囊内镜、胶囊内镜及全消化道造影对小肠出血病灶的总体检出率;通过自身对照,比较双气囊内镜和胶囊内镜对小肠出血诊断率;分析胶囊内镜对1次双气囊内镜检查明确诊断率的影响。结果105例小肠出血患者中,双气囊内镜检出克罗恩病24例,腺癌15例,慢性非特异性炎症12例,不明原因小肠溃疡10例,小肠间质肿瘤8例,小肠息肉8例,小肠血管畸形出血6例,钩虫病5例,麦克尔憩室及多发憩室5例,小肠淋巴瘤3例,无明显异常9例,阳性率91．4％（96／105）。其中40例进行胶囊内镜检查,病变检出率75．0％（30／40）;75例患者全消化道造影检查,病变检出率33．3％（25／75）。根据胶囊内镜结果1次双气囊内镜检查明确诊断率90．0％（36／40）,而根据临床特征及消化道造影结果1次双气囊内镜检查明确诊断率69．2％（45／65）。结论小肠疾病的主要病因是小肠良性溃疡（包括克罗恩病）、肿瘤、慢性炎症,其次是息肉、血管畸形、寄生虫感染、麦克尔憩室及淋巴瘤等。双气囊内镜对小肠出血诊断率高于胶囊内镜,胶囊内镜能提高1次双气囊内镜明确诊断率。