无外套管推进式电子小肠镜在小肠疾病诊断中的应用

目的 评价无外套管推进式电子小肠镜对小肠疾病的诊断价值和安全性。方法 对1994年11月～2004年10月间138例疑有小肠疾病患者行推进式电子小肠镜检查,分析其应用情况。结果 138例患者中,电子小肠镜越过屈氏韧带进入空肠113例（81．9％）,结果发现小肠疾病44例（31．9％）,包括十二指肠多发溃疡4例,十二指肠中下段病变19例,空肠病变21例。92例不明原因消化道出血患者中,37例发现病灶,阳性检出率为41．1％。无一例出现并发症。结论 推进式电子小肠镜检查是诊断小肠疾病的有效且安全的手段之一。     

无外套管推进式电子小肠镜在小肠疾病诊断中的应用

目的评价无外套管推进式电子小肠镜对小肠疾病的诊断价值和安全性.方法 对1994年11月～ 2004年10月间138例疑有小肠疾病患者行推进式电子小肠镜检查,分析其应用情况.结果 138例患者中,电子小肠镜越过屈氏韧带进入空肠113例(81.9%),结果发现小肠疾病44例(31.9%),包括十二指肠多发溃疡4例,十二指肠中下段病变19例,空肠病变21例.92例不明原因消化道出血患者中,37例发现病灶,阳性检出率为41.1%.无一例出现并发症.结论 推进式电子小肠镜检查是诊断小肠疾病的有效且安全的手段之一.     

推进式电子小肠镜检查15例报告

目的 评价推进式电子小肠镜检查拟小肠疾病的临床诊断价值及其安全性。方法 采用双入操作推进式插入法，不辅以外套管，循腔进镜，适当滑进，反复勾拉进退。结果 15例拟小肠疾病患者中14例越过屈氏韧带下50～100cm，平均插达屈氏韧带下80cm；另1例因十二指肠末端梗阻拟新生物，肠镜不能扩张未能进镜。总插镜成功率100％，病变检出率为66．7％。无严重并发症发生。结论 推进式电子小肠镜检查应作为检查十二指肠降部、水平部及上段空肠病变的首选方法。     

双气囊电子小肠镜在小肠疾病诊断中的临床应用

目的应用和评价双气囊电子小肠镜对小肠疾病患者的诊断价值及其安全性和耐受性。方法采用新近引用的双气囊电子小肠镜检查技术对临床怀疑有小肠疾病的15例患者进行检查,经口进镜8例,经肛门进镜6例,1例两端同时进镜。结果15例中13例有小肠疾病阳性发现,疾病检出率为86.7%,其中小肠腺癌2例,小肠克罗恩病2例,小肠血管畸形3例,糜烂出血性回肠炎1例,小肠间质瘤1例,空肠息肉1例,胃溃疡1例,回肠吻合口溃疡1例,空肠柿石1例。结论双气囊电子小肠镜是检查小肠疾病的一个可靠手段,疾病检出率高(86.7%,13/15),其观察范围大,图像清晰,视野控制自如,既能发现微小病变,又能同时进行活检。     

推进式电子小肠镜在小肠疾病诊治中的应用价值探讨

目的评价推进式电子小肠镜在小肠疾病诊治中的应用价值。方法回顾性分析1998年3月~2006年12月在我院消化科进行推进式电子小肠镜诊治的345例患者。结果318例越过屈氏韧带,小肠检查平均检查时间为30min。144例患者诊断有小肠疾病,检出率为41.74%。28例患者行内镜下止血术,13例患者行内镜下息肉切除术。无穿孔、出血、腹痛等严重并发症发生。结论推进式电子小肠镜检查仍是目前诊断小肠疾病,尤其空肠上段以上消化道疾病有效的方法,并可进行相应治疗,安全、可靠。     

疑似小肠疾病患者单气囊小肠镜检查

目的分析单气囊小肠镜检查特点及对小肠疾病的诊断价值。方法对怀疑小肠疾病的52例患者行单气囊小肠镜检查,观察临床症状、疾病诊断、进镜方式、进镜时间、患者的耐受性、检出率及并发症的发生率。结果经口进镜40例次,经肛进镜33例次;检出的小肠病变为40例;单气囊小肠镜对不明原因消化道出血的检出率明显高于腹痛、腹泻待查等患者(P<0.05);检出疾病主要有肿瘤性病变、非特异性小肠炎、克隆恩病、血管病变等;经口进镜时间明显短于经肛进镜(P<0.05);患者耐受性好,无并发症发生。结论单气囊小肠镜是目前诊断小肠疾病安全、可靠的方法 。     

推进式电子小肠镜的临床应用评价

目的 评价推进式电子小肠镜临床应用的适应证、检查范围和临床价值. 方法 对多项检查阴性、疑诊小肠病变的41例患者行推进式电子小肠镜检查,采用双人操作法. 结果 41例中成功完成检查者40例.小肠镜前端可达到Treitz韧带下30～100cm,发现十二指肠、空肠病变12例（占29.3%）,食管、胃病变8例.未发生与操作相关的严重并发症. 结论 推进式电子小肠镜是一种安全、可靠的十二指肠和上段空肠疾病的检查手段.     

青海地区单气囊小肠镜在小肠疾病中的初步应用体会

目的:评价单气囊小肠镜对小肠疾病的诊断价值及其安全性.方法:对26例疑患小肠疾病患者进行单气囊小肠镜检查,13例患者接受双侧进镜检查,单纯经口进镜4例,经肛进镜9例.结果:26例患者中检出阳性病变20例,检出率为76.9％,其中非特异性小肠炎症5例,血管畸形2例,息肉3例,小肠淋巴瘤3例,憩室1例,肠结核1例,小肠孤立性溃疡2例,克罗恩病2例,小肠腺癌1例.不明原因消化道出血患者病变检出80％ (12/15),其他临床症状患者病变检出率为72.7％(8/11).结论:单气囊小肠镜诊断小肠疾病准确可靠.     

空回肠出血诊断分析

目的 :探讨空回肠出血的病因及诊断方法的选择。方法 :33例空回肠出血患者分别行胃镜、结肠镜、全消化道钡餐、核素扫描、血管造影、剖腹探查及术中肠镜等单项或多项检查 ,手术及病检证实。结果 :33例患者中 ,小肠肿瘤占 13例 (39 39% ) ,以平滑肌瘤多见 ,小肠感染性疾病 8例 (2 4 2 4% ) ,Meckel’s憩室 7例 (2 1 2 1% ) ,血管病变(包括血管瘤 ) 3例 (9 1% ) ,其它 2例 (6 0 6 % )。其临床表现为不同程度的消化道出血 ,黑便多见 (4 2 42 % ) ,约 1/ 3的患者伴有腹痛 ,以中度贫血为多见 (4 8 48% )。核素扫描检查 7例 ,5例均发现小肠出血部位 ,经手术和病理检查证实均为Meckel’s憩室 ;胃镜和 /或结肠镜检查 2 0例 ,5例提示小肠病变 ;剖腹探查 6例 ,其中 1例蓝色橡皮疱痣血管瘤、1例血管畸形、1例坏死性小肠炎 ,3例经术中肠镜发现 1例副伤寒、1例空肠平滑肌瘤、1例肠道钩虫病。结论 :空回肠出血以肿瘤为最常见病因 ,对不明原因的中度贫血伴黑便者应高度怀疑小肠病变 ,核素检查对诊断Meckel’s憩室阳性率高。     

双气囊电子小肠镜在小肠疾病诊断中的作用

目的评价双气囊电子小肠镜在小肠疾病中的诊断价值。 方法对135例拟诊或需排除小肠疾病的患者在静脉麻醉下进行155次小肠镜检查。92例单纯经口进镜,23例单纯经肛门进镜,20例经口和肛门两次进镜。 结果小肠疾病的整体检出阳性率为78.52%（106/135）。其中良恶性肿瘤45例,克罗恩病26例,小肠非特异性炎症14例,小肠淋巴管扩张7例,小肠毛细血管畸形6例,过敏性紫癜2例,小肠气囊肿症、肠套叠、回肠憩室、双回肠畸形、小肠息肉和小肠蛔虫症各1例。对小肠出血的检出阳性率为86.84%（33/38）。经口及肛门进镜耗时分别约30和50分钟。 结论双气囊电子小肠镜是目前诊断小肠疾病最有效和最准确的方法。     

双气囊电子小肠镜检查34例分析

目的:讨论双气囊小肠镜对小肠疾病的诊断价值及安全性、耐受性评价。方法:自2010年1月至2011年10月共有34例怀疑小肠疾病患者在静脉复合麻醉下行双气囊小肠镜检查。结果:34例患者中有30例发现小肠病变,总体诊断率88.2%。其中克罗恩病2例,小肠恶性肿瘤3例,小肠间质瘤2例,脂肪瘤2例,多发性溃疡3例,非特异性炎症6例,小肠息肉3例,小肠憩室2例,静脉瘤1例,小肠毛细血管扩张症2例,小肠淋巴滤泡增生2例,肠结核2例,4例未发现明显病变。未发生肠穿孔、出血、胰腺炎等并发症,未出现全身麻醉并发症。结论:双气囊小肠镜检查安全,可靠,阳性率高。是诊断小肠疾病的有效手段。     

245例双气囊电子小肠镜检查应用分析

目的 评价双气囊电子小肠镜对小肠疾病患者的诊断价值及其安全性.方法 对2007年2月至2010年7月间245例有消化道症状,经胃镜、结肠镜等检查为阴性者,采用双气囊电子小肠镜检查,根据病情选择进镜方式.结果 244例完成预定检查,1例患者因回盲瓣严重变形,检查失败,小肠镜未能进入回肠.在244例完成双气囊电子小肠镜检查...     

双气囊小肠镜在胶囊内镜检查阴性小肠疾病诊断中的作用

目的通过双气囊小肠镜对胶囊内镜检查阴性疾病的诊断,探讨胶囊内镜在不同小肠病变的诊断作用。 方法对156例疑诊为小肠疾病患者行胶囊内镜检查,随后对87例阴性患者进一步行双气囊小肠镜检查。 结果156例患者中69例胶囊内镜检查阳性,其中不明原因消化道出血52例,有警报症状和体征17例,总体阳性诊断率44．2％（69／156）,检出的主要病变有：小肠炎症（粘膜糜烂、溃疡）32例,小肠肿瘤24例,小肠血管发育不良9例,小肠憩室1例,白塞病2例,小肠结核钙化灶1例。87例胶囊内镜检查阴性患者经双气囊小肠镜检查额外检出小肠病变12例,对于胶囊内镜检查阴性患者双气囊小肠镜诊断率为13．8％（12／87）,其中不明原因消化道出血9例,有警报症状和体征3例,检出病变有：小肠憩室5例,小肠血管发育不良4例,小肠溃疡1例,小肠肿瘤2例。 结论胶囊内镜对于表现为隆起性、浸润性、溃疡和多发性病灶小肠疾病具有较高的的诊断能力,但对小肠憩室和病变局限病灶较小的小肠血管发育异常者诊断能力有限,与双气囊小肠镜有效结合运用能大为提高小肠疾病的诊断率和准确性。     

麻醉双气囊电子小肠镜的临床应用

目的 评价麻醉双气囊电子小肠镜的临床应用价值。方法 70例疑有小肠疾病者，根据需要分成观察组45例。麻醉下进行小肠镜检查；对照组25例，无麻醉下进行检查。结果 观察组均能安全的完成检查，无任何并发症；对照组有7例不能按要求完成检查，仅完成72％。结论 麻醉下行电子小肠镜检查是一种安全有效的方法。     

Application of double-balloon enteroscopy in the diagnosis and therapy of small intestinal diseases

Background X-ray of the digestive tract and radionuclide examination could not accurately detect diseases of the small intestine. Double-balloon enteroscopy has been used to increase the detection rate of these diseases in addition to endoscopic biopsy and therapy. The purpose of this study was to determine the value of double-balloon enteroscopy in the diagnosis and treatment of diseases of the small intestine. Methods A total of 258 double-balloon enteroscopies via the mouth and/or anus were performed in 208 patients. If no lesion was detected on one side （mouth or anus）, examination on the other side （anus or mouth） was made. If active small intestinal bleeding was detected, endoscopic hemostasis was done to treat the bleeding. Results In the 208 patients, 50 were subjected to double-balloon enteroscopy via both mouth and anus. Lesions were detected in 151 patients, giving a rate of 72.6% （151/208）. The detection rates for obscure digestive tract bleeding, diarrhea, abdominal pain and weight loss were 90.2% （92/102）, 64.9% （24/37）, 48.5% （16/33） and 43.3% （13/30）, respectively. Lesions of the 151 patients were confirmed by endoscopic biopsy, surgery, clinical studies, and follow-up. In the 102 patients with bleeding of the digestive tract, active bleeding was detected in 27 patients. Endoscopic hemostasis was successful in 25 of them （92.6%, 25/27）. No serious complications occurred in all the patients, the average time for the procedure was 100 minutes. Conclusions Double-balloon enteroscopy is safe, effective in the diagnosis of diseases of the small intestine in addition to endoscopic therapy.     

The role of capsule endoscopy combined with double-balloon enteroscopy in diagnosis of small bowel diseases

Background The diagnosis of small bowel diseases remains relatively inefficient using traditional imaging techniques. Capsule endoscopy （CE） and double-balloon enteroscopy （DBE） are two novel methods of enteroscopy for examining the entire small bowel. The aim of this study was to evaluate the detection rate and diagnostic accuracy of CE and DBE in patients with suspected small bowel diseases and to investigate the clinical significance of combined use of these two novel modalities. Methods Two hundred and eighteen patients were evaluated for suspected small bowel disease, including 116 with obscure gastrointestinal bleeding and 102 with obscure abdominal pain or chronic diarrhea. One hundred and sixty-five out of these patients underwent CE first and 53 patients underwent DBE （under anesthesia with propofol） first. DBE was recommended after negative or equivocal evaluation on CE and vise versa. Introduction of the endoscope during DBE was either orally or anally and the patients were referred for a second procedure using the opposite route several days later when no abnormalities were found on the first procedure. The detection rates, diagnostic accuracy, tolerance and frequency of adverse events of these two modalities were then analyzed. Results Failure of the procedure was seen in one patient with CE and in two patients with DBE. Sixty-four DBE procedures were carded out in 51 patients; by the oral route in 34 cases, the anal route in 4 and both routes in 13 cases. The overall detection rate of small bowel diseases using CE （72.0%, 118/164） was superior to that with DBE （41.2%, 21/51）; X2=16.1218, P〈0.0001. The diagnostic rate （51.8%, 85/164） was also higher than that with the latter procedure （39.2%, 20/51）, but was not significantly different （X^2=2.4771, P〉0.05）. Furthermore, the detection rate of small bowel diseases in patients with obscure gastrointestinal bleeding using CE （88.0%, 88/100） was superior to that of DBE （60.0%, 9/15）; X2=7.7457, P=0.0054. Lesions were detected by DBE in 1 out of 4 patients in whom CE had a negative result. Suspected findings by CE were confirmed by DBE combined with biopsy in 12 out of 15 patients. On the other hand, small bowel lesions were identified by CE in all 3 patients after negative evaluations by DBE. There were no severe complications during or after either of the two procedures. Conclusions The detection rate of small bowel diseases by CE is very high. CE should be selected for the initial diagnosis in patients with suspected small bowel diseases, especially in patients with obscure gastrointestinal bleeding. DBE appears to be inferior to CE in the diagnosis of small bowel diseases. However, it was shown that abnormalities could still be identified by DBE in patients with normal images or used to confirm suspected findings from CE. DBE can also serve as a good complementary approach after an initial diagnostic imaging using CE.     

双气囊小肠镜与小肠钡灌诊断小肠疾病的对照研究

目的 比较双气囊小肠镜和小肠钡灌检查对小肠疾病的诊断价值。方法 2003年3月至2004年9月,43例经多项常规检查阴性、疑为小肠疾病患者分别行双气囊小肠镜和小肠钡灌检查,结合手术和病理所见,对照两者的病因诊断率,就其整体检出率和对小肠基本病变诊断的准确性进行比较。结果 小肠镜发现36例病灶,整体检查阳性率83．7％;小肠钡灌发现22例病变,整体检查阳性率51．2％。小肠镜检出小肠肿瘤13例,炎性、溃疡性病变20例,血管畸形3例;小肠钡灌分别检出7例、15例、0例。结论 在小肠疾病的整体检出率和病因诊断率方面,双气囊小肠镜要优于小肠钡灌。     

双气囊小肠镜与CT对小肠肿瘤的诊断效果比较分析

目的:探讨双气囊小肠镜与CT对小肠肿瘤的诊断效果,为小肠肿瘤的合理诊断提供方法参考。方法:临床怀疑为小肠肿瘤的患者120例分别进行双气囊小肠镜和小肠CT诊断,观察诊断的敏感性与特异性。结果:经过病理观察、120例临床怀疑为小肠肿瘤患者中最终经病理证实110例为小肠肿瘤,双气囊小肠镜诊断的敏感性为91.3%(105/115),特异性为100%(5/5)。CT诊断的敏感性为97.3%(109/1 12),特异性87.5%(7/8)。结论:双气囊小肠镜与CT对小肠肿瘤的诊断敏感性与特异性都比较好,但是都存在一定的缺陷,在以后的诊断中需要两者互补结合诊断,以促进小肠肿瘤的合理诊断与治疗。     

Capsule endoscopy and push enteroscopy in the diagnosis of obscure gastrointestinal bleeding

Background In obscure gastrointestinal (GI) bleeding, it is often difficult to detect the bleeding sites located in the small bowel with conventional radiological, scintigraphic or angiographic techniques. Push enteroscopy and capsule endoscopy are currently considered to be the most effective diagnostic procedures. The aim of this study was to compare the detection rates between capsule endoscopy and push enteroscopy. Methods From May 2002 through January 2003, we prospectively examined by capsule endoscopy 39 patients with suspected small bowel diseases, in particular GI bleeding of unknown origin in Renji Hospital. Among them, 32 complained of obscure recurrent GI bleeding. Between January 1993 and October 1996, we used push enteroscopy on 36 patients who suffered from unexplained GI bleeding. All patients had prior normal results on gastroscopy, colonoscopy, small bowel barium radiography, scintigraphy and/or angiography. Results M2A capsule endoscopy disclosed abnormal small bowel findings in 26 (82%) out of 32 patients. Twenty-one of them had significant pathological findings explaining their clinical disorders. Diagnostic yield was therefore 66% (21 of 32 patients). Definite bleeding sites diagnosed by capsule endoscopy in 21 patients included angiodysplasia (8), inflammatory small-bowel (5), small-bowel polyps (4), gastrointestinal stromal tumour (2), carcinoid tumour and lipoma (1), and hemorrhagic gastritis (1). Push enteroscopy detected the definite sources of bleeding in 9 (25%) of the 36 patients. Patients with definite bleeding sources included angiodysplasias (2), leiomyosarcoma (2), leiomyoma (1), lymphoma (1), Crohn’s disease (1), small-bowel polyps (1) and adenocarcinoma of ampulla (1). Suspected bleeding sources were shown by push enteroscopy in two additional patients (6%), and in other five patients (16%) by capsule endoscopy. Conclusions The present study of patients with obscure GI bleeding showed that capsule endoscopy significantly superior to push enteroscopy in detecting GI bleeding (P&lt;0.001). Capsule endoscopy is safe and painless, and should become the initial diagnostic choice for patients with obscure GI bleeding.