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。

Double-balloon endoscopy and capsule endoscopy for small intestinal bleeding

Objective To study the diagnostic value of double-balloon endoscopy (DBE) and capsule endoscopy (CE) for small intestinal bleeding. Methods Overall detection rates of small intestinal bleeding with DBE, CE and the whole alimentary tract barium meal were compared. Positive rates of bleeding detection with DBE and CE were compared within the same patients. Influence of CE on one-procedure rate of DBE was analyzed. Results In 105 cases of small intestine bleeding, DBE detected 24 cases of Crohn's disease, 15 adenocarcinoma, 12 chronic nonspecific inflammation, 10 small intestinal ulcer of unknown reason, 8 entero-mesenchymoma, 8 polypus, 6 vascular deformation hemorrhage, 5 ancylostomiasis, 5 Mechel's diverticula ( including multiple diverticula), 3 lymphoma and 9 of no evident abnormalities. The positive detection rate of DBE is 91.4% (96/105). Disease detection rates of CE and whole alimentary tract barium meal were 75.0% (30/40) and 33.3% (25/75), respectively. The one-procedure rate of DBE is 90% (36/40) based on CE results, but it was only 69. 2% (45/65) according to clinic features and the whole alimentary tract barium meal. Conclusion The main causes of small intestinal bleeding are benign ulcers (including Crohn's disease) and tumor, as well as chronic inflammation. Polyps, vascular deformation, parasitosis, Mechel's diverticulum and lymphoma are the secondary causes.DBE is superior to CE in diagnosis of small intestine bleeding, but CE can increase the one-procedure rate of DBE.