胶囊内镜对不明原因消化道出血最佳检查时机的研究

目的：探讨胶囊内镜（capsule endoscopy,CE）检查不明原因消化道出血的时机。方法：选择我院2002年5月至2005年1月91例不明原因消化道出血患者,共行94次CE检查。根据其检查时出血情况不同,分成2组,A组为活动性出血组（41例,包括显性出血37例和持续隐性出血4例）,B组为出血停止组（50例）。结果：CE检查的阳性率为74.7%（n=68）,疑诊率为11.0%（n=10）,检出率85.7%,阴性率为14.3%（n=13）。活动性出血组的CE检出率明显高于出血停止组（95.1%比78%,P=0.032）,但显性出血者与隐性出血者间检出率的差异无统计学意义（97.3%比75.0%,P=0.188）;出血停止组中,2周内刚停止出血者（29例）的检出率亦明显高于出血停止2周以上（21例）者（93.1%比57.1%,P=0.004）,但活动性出血时与出血停止2周内的检出率差异则无统计学意义（95.1%比93.1%,P〉0.05）。结论：对不明原因消化道出血,CE最佳检查时机为少量活动性出血时和出血停止2周内,该时段检出率高。

Study of the best candidates for capsule endoscopy for obscure gastrointestinal bleeding

Objective To explore the best time point of capsule endoscopy （CE） for examining obscure gastrointestinal bleeding. Methods From May 2002 to Jan 2005, 94 CE examinations were performed in 91 consecutive patients with obscure gastrointestinal bleeding. In accordance with the status of bleeding when receiving CE examination, the patients were divided into two groups： active bleeding group （41 patients, including 37 with obvious bleeding and 4 with continuous occult bleeding） and bleeding stopped group （50 patients）. Results CE was definitely positive in 74.7% cases （n=68）, suspiciously positive in 11.0% cases （n=10）, with an overall detecting rate 85.7%; and was negative in 14.3% cases （n=13）. The detecting rate of CE was 95.1% （n=39） in the active bleeding group, significantly higher than the 78.0% （n=39） in the bleeding stopped group（P=0.032）. However, no significant difference was found between those with obvious bleeding and occult bleeding （97.3% vs 75.0%, P=0.188）. In the bleeding stopped group, the detecting rate of those having their bleeding stopped less than 2 weeks （27/29, 93.1%） was significantly higher than those having their bleeding stopped longer than 2 weeks （12/21, 57.1%）（P=0.004）. However, no significant difference was found between the detecting rates of those with active bleeding （95.1%, 39/41） and those with their bleeding stopped less than 2 weeks （93.1%, 27/29）（P〉0.05）. Conclusions The best time point of CE is when the patient is at active bleeding or having his/her bleeding stopped less than 2 weeks. It can increase the detecting rate and allow the patient to have proper treatment.