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目的探讨小肠溃疡性病变的临床、内镜、病理等特点。方法临床怀疑小肠疾病者155例。按术者操作内镜并送镜,助手辅助进外套管的方法。结果 155例患者中,125例发现病变,阳性率80.6%。检出的主要疾病为小肠溃疡(含克罗恩病)、慢性炎症、美克尔憩室、间质瘤、血管畸形、小肠癌等。其中92例怀疑小肠出血者,检查阳性84例(91.3%);39例腹痛患者中,阳性24例(61.5%);腹泻、腹胀、消瘦23例,阳性16例(69.6%)。病变位于胃及十二指肠9例,小肠病变115例,大肠病变1例,全消化道未发现病变30例。在155例接受双气囊内镜(DBE)检查的患者中,检出小肠溃疡性病变43例;病灶数为单个12例,多个(2个及以上)31例;病变位于空肠的18例,回肠20例,空肠和回肠都有病变的5例。DBE 结合组织学检查对美克尔憩室、间质瘤、癌、血管病变、肠黏连的诊断与手术后诊断是完全相符的;而对溃疡性病变(主要是克罗恩病)的诊断与手术后诊断却相差较大,符合率57.1%(4/7)。发生小肠穿孔和急性肠梗阻并发症各1例。结论 DBE 目前是诊断小肠疾病安全、有效的方法,特别在发现病变方面,但对溃疡性病变的定性即使结合活检也未必是特异的,及时行外科处理对某些溃疡性病变的诊断和治疗都是有益的。
Objective To investigate the clinical, endoscopic and pathological characteristics of small intestinal ulcer disease. Methods Clinical suspicion of intestinal diseases in 155 cases. According to the surgeon to operate the endoscope and send the mirror, helper assisted into the outer tube method. Results Among the 155 patients, 125 cases found lesions with a positive rate of 80.6%. The main diseases detected were small intestinal ulcer (including Crohn’s disease), chronic inflammation, merkel diverticulum, interstitial tumor, vascular malformation, small intestine cancer and so on. Of the 92 patients with suspected small intestinal hemorrhage, 84 were positive (91.3%). Of the 39 patients with abdominal pain, 24 were positive (61.5%), 23 were diarrhea, abdominal distension and emaciation, and 16 were positive (69.6%). Lesions in the stomach and duodenum in 9 cases, 115 cases of small bowel disease, colorectal lesions in 1 case, 30 cases of lesions found in the whole digestive tract. Among the 155 patients undergoing double balloon endoscopy (DBE), 43 were diagnosed as ulcerative lesions of the small intestine; the number of lesion was single in 12 cases, multiple (2 or more) in 31 cases; lesion was located in jejunum in 18 cases, 20 cases of ileum, jejunum and ileum have lesions in 5 cases. DBE combined with histological examination of merkel diverticulum, stromal tumor, cancer, vascular disease, intestinal adhesion diagnosis and postoperative diagnosis is completely consistent; and ulcerative lesions (mainly Crohn’s disease) diagnosis and Postoperative diagnosis is quite different, in line with the rate of 57.1% (4/7). A case of intestinal perforation and acute intestinal obstruction occurred in 1 case. Conclusions DBE is currently a safe and effective method for the diagnosis of small bowel diseases, especially in the detection of pathological changes. However, the characterization of ulcerative lesions may not be specific even in combination with biopsy, and timely diagnosis and treatment of some ulcerative lesions It is good.