CAJ | 학술논문

目的报告应用双气囊小肠镜(double-balloon enteroscopy,DBE)于小儿下消化道出血的结果及我们在诊断和治疗上的经验.方法 2011年8月至2014年9月对26例大量暗红色血便患儿,控制出血症状、排除内科疾病后,DBE经肛门进镜,利用气囊的反复充气、放气,进镜小肠,寻及病变后如为Meckel憩室、肿瘤,摆动镜头光源至脐环下经脐环切开,如不能至脐环下则经腹壁小切口,提出病变予切除、肠吻合;如为息肉予圈套后电凝切除.结果诊断Meckel憩室14例,均成功微创手术;息肉病3例,均予电凝切除所见息肉;淋巴瘤2例,均成功微创手术;1例1岁患儿因镜身过回盲瓣困难而进镜失败,随访14个月未见再出血;6例阴性检查结果,其中5例经3～35个月随访未见再出血,1例随访7个月后再发下消化道出血,经腹腔镜探查仍阴性,继随访观察中.无围检查、手术期并发症.结论 DBE对小儿下消化道出血不仅具有诊断价值,更能达到微创治疗的效果.
목적 보고응용쌍기낭소장경(double-balloon enteroscopy,DBE)우소인하소화도출혈적결과급아문재진단화치료상적경험.방법 2011년8월지2014년9월대26례대량암홍색혈편환인,공제출혈증상、배제내과질병후,DBE경항문진경,이용기낭적반복충기、방기,진경소장,심급병변후여위Meckel게실、종류,파동경두광원지제배하경제배절개,여불능지제배하칙경복벽소절구,제출병변여절제、장문합;여위식육여권투후전응절제.결과 진단Meckel게실14례,균성공미창수술;식육병3례,균여전응절제소견식육;림파류2례,균성공미창수술;1례1세환인인경신과회맹판곤난이진경실패,수방14개월미견재출혈;6례음성검사결과,기중5례경3～35개월수방미견재출혈,1례수방7개월후재발하소화도출혈,경복강경탐사잉음성,계수방관찰중.무위검사、수술기병발증.결론 DBE대소인하소화도출혈불부구유진단개치,경능체도미창치료적효과.
Objective To report our experiences of applying doubleballoon enteroscopy (DBE) for lower gastrointestinal hemorrhage in children.Methods From August 2011 to September 2014,retrograde DBE was performed on 26 pediatric patients with bloody diarrhea.With alternate inflation and deflation of balloons at the tip of endoscope and overtube,enteroscope was inserted into intestine.When a Meckel diverticulum or tumor was identified,enteroscopic light source was swung to umbilicus,a small incision was made at umbilicus and intestine indicated by enteroscopic light source was extracted for lesion removal and intestinal anastomosis.When light source could not be swung,a 2 cm incision was made on abdominal wall.And the subsequent steps were similar.Electrosurgical snare resection was performed for polyps.Results Meckel diverticulum (n =14) and lymphoma (n =2) underwent mini-invasive procedures.Polyps (n =3) had electrosurgical extirpation.One patient aged 1 year failed DBE examination since enteroscope could not pass through ileocecal valve.And there was no recurrence of bloody diarrhea during the follow-ups.There were 6 patients with negative results.One of them had recurrent bloody diarrhea and a negative laparoscopic exam and the remainder had no recurrent bloody diarrhea during the follow-ups.No complications were observed during examinations or operative period.Conclusions With great diagnostic values,DEB is also miniinvasively efficacious for lower gastrointestinal hemorrhage in children.