胶囊内镜的临床应用

目的 小肠疾病很难诊断，现有的诊断技术又不尽如人意，而胶囊内镜（M2A）能发现整个小肠内的微小病变，且为非侵入性，患者无需住院，因此，对胶囊内镜在小肠疾病诊断中的价值。依从性和安全性进行评估。方法 自2002年5月至9月，我们对经结肠镜，胃镜，X线钡餐造影，小肠钡灌造影，血管造影或核素扫描等检查未发现异常的15例疑患小肠疾病的患者，进行胶囊内镜检查，其中不明原因的消化道出血12例。结果 15例中发现病灶11例（73.3%)，包括血管发育不良，Dieulafoy病，毛细血管扩张征，静脉扩张，息肉样病变，黏膜下肿瘤，脂肪瘤，口疮样小溃疡（Aphthous ulcer)，克罗恩病类癌及出血性胃炎等，其中4例患者同时存在2种病灶，所获取的图像质量良好，胶囊停留于胃内的平均时间为82min(6-311min)，小肠内平均运行时间为248min(104-396min)，平均到达盲肠时间为336min(180-470min)，平均记录时间为449min(300-510min)，医师对胶囊内镜所传输图像的平均读片时间为82min(30-120min)，平均获取照片数为57919张，胶囊平均排出体外时间为33h(24-48h)，整个操作过程患者耐受性甚佳，无任何痛苦，吞咽胶囊无任何困难，检测过程中无任何并发症发生。结论 胶囊内镜是对小肠疾病具有诊断价值的医疗设备，其安全性高，依从性好。

Clinical application of capsule endoscopy

Objective The diagnosis of small bowel disorders is often very difficult, and available techniques to identify small bowel lesions are unsatisfactory. Video capsule endoscopy (M2A) is an innovative technique that can detect very small mucosal lesions in the entire small bowel and can be applied to outpatients. This study was to explore the diagnostic value, tolerance, and safety of capsule endoscopy in the diagnosis of small bowel diseases. Methods From May through September 2002, we examined 15 patients with suspected small bowel diseases, in particular the gastrointestinal bleeding of unknown origin, and prior normal results on gastroscopy, colonoscopy, small bowel barium radiography, scintigraphy or selective angiography. Of the 15 patients, 12 complained with obscure recurrent gastrointestinal bleeding. Results M2A capsule endoscopy disclosed pathologic small bowel findings in 11 out of 15 patients (73.3%). Findings consisted of angiodysplasia, hereditary hemorrhagic telangiectasia, venous ectasia, Dieulafoy's disease, polypoid lesion, submucosal tumor, Crohn's disease, carcinoid tumor, lipoma, Aphthous ulcer, and hemorrhagic gastritis. Four patients had two or more different lesions. The images displayed were considered to be good. The capsule endoscopes remained in the stomach for an average of 82 min (range 6-311 min). The mean transit time in the small bowel was 248 min (range 104-396 min). The mean time of recording was 449 min (from 300-510 min). The mean time to reach the caecum was 336 min (180-470 min). The average time that the physician took to review the images transmitted by the capsule was 82 min (30-120 min). The average number of the images transmitted by the capsule was 57 919. The average time of the elimination of the capsule endoscopes appeared in the stool was 33 h (range 24-48 h). All 15 patients stated that the capsules were easy to swallow, painless and safe, no complications were observed. Conclusions Capsule endoscopy is useful for evaluating suspected small intestinal diseases, especially in patients with obscure gastrointestinal bleeding. It is safe and well tolerated.