CAJ | 학술논문

目的分析胶囊内镜(capsule endoscopy,CE)因技术和临床因素导致检查失败的原因及其对诊断的影响,评估其在特殊人群中使用的安全性.方法回顾性分析2002年5月至2006年5月4年间在上海仁济医院因可疑小肠疾病接受CE检查的300例患者.技术问题为与仪器设备相关的问题,临床问题为与患者相关的问题.分析上述两类问题发生情况及对诊断的影响并评估CE检查在儿童组、高龄组、安置起搏器者、胃毕-Ⅱ式术后者、肠道憩室者、小肠克罗恩病者及小肠息肉病者中使用的安全性.结果共出现4次技术问题(1.3%)(胶囊未被激活1例,胶囊内部电池电量＜6 h2例,图像下载失败1例),其中2次影响到CE的诊断;临床问题共出现99次(33.0%)(正常电池电量维持时间内CE未达回盲部95次,吞咽胶囊失败4次),35次(35.4%)影响诊断结果.儿童组6例中胶囊吞咽不能发生3例,外套管下胃镜辅助送入法可成功解决此问题;高龄组13例中CE滞留于食管内3例(23.0%);2例安置心脏起搏器患者CE检查中未发现仪器间互相干扰;2例胃毕-Ⅱ式术后者未发生CE滞留;16例肠道憩室者中1例发生滞留;42例克罗恩病者5例发生CE滞留,但无一发生急性肠梗阻;5例息肉病者中无一例发生CE滞留及肠梗阻.结论因CE自身技术因素导致检查失败者在临床应用中极少出现,所遇常见临床问题为正常电池电量维持时间内CE未达回盲部.CE对于小肠疾病而言是一项安全有效的检查方法.
목적 분석효낭내경(capsule endoscopy,CE)인기술화림상인소도치검사실패적원인급기대진단적영향,평고기재특수인군중사용적안전성.방법 회고성분석2002년5월지2006년5월4년간재상해인제의원인가의소장질병접수CE검사적300례환자.기술문제위여의기설비상관적문제,림상문제위여환자상관적문제.분석상술량류문제발생정황급대진단적영향병평고CE검사재인동조、고령조、안치기박기자、위필-Ⅱ식술후자、장도게실자、소장극라은병자급소장식육병자중사용적안전성.결과 공출현4차기술문제(1.3%)(효낭미피격활1례,효낭내부전지전량＜6 h2례,도상하재실패1례),기중2차영향도CE적진단;림상문제공출현99차(33.0%)(정상전지전량유지시간내CE미체회맹부95차,탄인효낭실패4차),35차(35.4%)영향진단결과.인동조6례중효낭탄인불능발생3례,외투관하위경보조송입법가성공해결차문제;고령조13례중CE체류우식관내3례(23.0%);2례안치심장기박기환자CE검사중미발현의기간호상간우;2례위필-Ⅱ식술후자미발생CE체류;16례장도게실자중1례발생체류;42례극라은병자5례발생CE체류,단무일발생급성장경조;5례식육병자중무일례발생CE체류급장경조.결론 인CE자신기술인소도치검사실패자재림상응용중겁소출현,소우상견림상문제위정상전지전량유지시간내CE미체회맹부.CE대우소장질병이언시일항안전유효적검사방법.
objective To analyse the incidence of technical breakdown and clinical problem leading to the failure of capsule endoscopy examination and their influence on the diagnosis and to evaluate its feasibility and safety in special patient population.Methods A retrospective study of 300 consecutive patients referred to Renji Hospital for evaluation of suspected small bowel diseases between May 2002 and May 2006 was done.This included 300 consecutive patients.The median age of the patients was 51y (range,3～91Y).The young children group was defined as less than 10 years and the elderly group as more than 80 years.Technical problems were those related to the functioning of the equipment and clinical problems were those related to the patient.The incidence and the type of above-mentioned events and their influence on the diagnosis were analyzed.The safety and feasibility of the capsule endoscopy procedure were evaluated in the young children group,elderly group and patients with pacemakers,gastrectomy and Billroth Ⅱ gastrojejunostomy,intestinal diverticula,Crohn's disease and polyp of small intestine.Results A total of 300 patients were involved.The incidence of technical problems was 1.3%.including one case of failing in activating the capsule,one case of failing in loading the data and two cases of short life of battery.Failure of diagnosis was encountered in two cases.The incidence of clinical problems was 33.0%(99 cases)and they caused 35.4%(35 cases)failure of diagnosis in the 99 cases.Three patients in the young children group were unable to swallow the capsule and endoscope-guided overtube technique was used with success in all.In the elderly group.the incidence of capsule retaining in the oesophagus and stomach was as high as 23.0%.In two patients with pacemaker no interference between pacemaker and capsule was detected.In two patients with Billroth Ⅱ gastrojejunostomy uo capsule retention occurred.In 16 patients with diverticulum,capsule retention occurred in 1 case(6.0%).In 42 patients with Crohn's disease,capsule retention occurred in 5 cases.No acute gastrointestinal obstruction was found in the 42 patients with Crohn's disease and in 5 patients with polyp of small intestine.Conclusions With capsule endoscopy technical mistakes causing failure were very rare.The majority of the clinical problems were related to the inability capsule to reach the colon during the recording time.Capsule endoscopy provides a well-tolerated,safe and effective tool to investigate the gastrointestinal diseases.especially some small bowel diseases.