双气囊小肠镜在不完全性小肠梗阻中的诊疗作用

目的:评价双气囊小肠镜(DBE)在诊断和治疗小肠不全性梗阻中的临床应用价值.方法:2004-04/2011-09,对107例不完全性小肠梗阻患者进行了DBE检查,并选择部分患者进行DBE镜下治疗.结果:107例不完全性肠梗阻患者共接受DBE检查189例次(经口检查122例,经肛门检查67例,其中双侧对接检查45例).共有98例明确了梗阻原因,诊断率为91.6%(98/107).对其中64例患者(56例为发现小肠巨大息肉的Peutz-Jeghers综合征患者,8例为良性小肠狭窄患者)共进行了175例次镜下治疗:包括小肠息肉切除167例次,扩张治疗8例次.50例患者(78.1%,息肉切除45例,扩张治疗5例)经内镜治疗后肠梗阻症状消失或缓解.189例次DBE检查或治疗过程中出现3例小肠穿孔,2例引起血色素下降的消化系出血,严重并发症发生率2.7%(5/189).结论:DBE对不完全性小肠梗阻患者具有较高的诊断率,并能对部分患者提供镜下治疗,避免了不必要的外科手术,在不完全小肠梗阻的诊断和治疗中具有重要临床应用价值.

Value of double-balloon endoscopy in the diagnosis and treatment of incomplete intestinal obstruction

AIM:To evaluate the diagnostic yield and therapeutic impact of double-balloon endoscopy(DBE) in patients with incomplete intestinal obstruction.METHODS:From April 2004 to September 2011,DBE was preformed in 107 patients with incomplete intestinal obstruction.Some of them underwent DBE treatment.RESULTS:A total of 189 DBE procedures(122 via an oral approach,67 via an anal approach,45 via both approaches) were performed in 107 patients with incomplete intestinal obstruction.DBE identified the causes of intestinal obstruction in 98 patients(91.6%).Sixty-four patients(56 patients having Peutz-Jeghers syndrome with huge polyps and 8 patients having benign stricture of the small intestine) underwent 175 DBE endoscopic treatments:polypectomies(n = 167) for huge polyps and dilation therapy(n = 8) for entero stenosis.After therapeutic endoscopy,the symptoms of intestinal obstruction disappeared or were alleviated in 50 patients(78.1%,45 cases undergoing polypectomy and 5 cases undergoing dilation therapy).Among 189 DBE procedures,five cases of serious complications(2.7%,three cases of small intestine perforation and two cases of bleeding with a fall in Hb) occurred.CONCLUSION:DBE has a high diagnosis rate in patients with incomplete intestinal obstruction and provides a treatment to some patients to avoid unnecessary abdominal surgery.