胶囊内镜在儿童小肠疾病中的临床应用价值

Clinical value of capsule endoscopy for intestinal diseases in children

摘要:

目的 评估胶囊内镜（capsule endoscopy，CE）在儿童患者小肠疾病诊断中的安全性和有效性。方法 回顾性分析2018年10月—2020年9月在西安市儿童医院接受胶囊内镜的113例患儿临床资料，分析胶囊内镜检查的完成率、胃及小肠通过时间、病变检出率、不良反应和并发症。结果 113例患儿中男78例（69.03%）、女35例（30.97%），年龄（99.8±44.7）个月（9~195个月），7岁以下31例（占27.43%）；体重最低9 kg，身高最低70 cm。患儿中经口吞入胶囊87例（76.99%），为经口吞入组，最小年龄4岁3个月；经胃镜置入胶囊26例（23.01%），为经胃镜置入组，最大年龄9岁2个月。患儿中以不明原因腹痛（47.79%）及不明原因消化道出血（31.89%）多见。胶囊内镜检查完成率97.35%（110/113），小肠阳性病变检出率31.81%（35/110）。经胃镜置入组小肠通过时间显著长于经口吞入组［（461.04±129.27）min比（288.23±107.84）min，t=5.646，P<0.01］。不同性别、不同年龄组及不同镜检结果组胃及小肠通过时间差异均无统计学意义（P>0.05）。胶囊阳性结果与吞入方式（P=0.401，OR=2.562，95%CI：0.284~23.077）、性别（P=0.154，OR=2.352，95%CI：0.726~7.616）、年龄（P=0.949，OR=1.007，95%CI：0.816~1.242）、检查原因（P=0.246）、小肠通过时间（P=0.219，OR=1.003，95%CI：0.998~1.008）等均无相关性。所有患者在检查中无胶囊滞留等并发症发生。结论 胶囊内镜检查在儿童的开展具有无创、快速、简单等优点，能够提升儿童小肠疾病阳性诊断率，可在儿童患者中进一步推广。

Abstract:

Objective To evaluate the safety and effectiveness of capsule endoscopy for the diagnosis of intestinal diseases in children. Methods Clinical data of 113 pediatric patients who received capsule endoscopy in Xi''an Children''s Hospital from October 2018 to September 2020 were retrospectively analyzed. The completion rate, passage time of stomach and small intestine, lesion detection rate, adverse reactions and complications of capsule endoscopy were analyzed. Results Among 113 pediatric patients, 78 (69.03%) were male and 35 (30.97%) were female. The age was (99.8±44.7) months (9-195 months), and 31 (27.43%) were under 7 years old. The minimum weight was 9 kg and the minimum height was 70 cm. Eighty-seven pediatric patients (76.99%) swallowed capsules orally (the oral group) with the minimum age of 4 years and 3 months. Capsules were implanted in 26 pediatric patients (23.01%) under gastroscopy (the gastroscopic group), with the maximum age of 9 years and 2 months. Unexplained abdominal pain (47.79%) and unexplained gastrointestinal bleeding (31.89%) were common in the pediatric patients. The completion rate of capsule endoscopy was 97.35% (110/113), and the detection rate of lesions in small intestine was 31.81% (35/110). The passage time of small intestine in the gastroscopic group was significantly longer than that of the oral group (461.04±129.27 min VS 288.23±107.84 min, t=5.646, P<0.01). There was no significant difference in the passage time of stomach or small intestine among different genders, different ages or different endoscopic examination results (P>0.05). The positive results of capsule were not correlated with the method of ingestion (P=0.401, OR=2.562, 95%CI:0.284-23.077), gender (P=0.154, OR=2.352, 95%CI:0.726-7.616), age (P=0.949, OR=1.007, 95%CI:0.816-1.242), examination reason (P=0.246) or small intestine passage time (P=0.219, OR=1.003, 95%CI:0.998-1.008). No complications such as capsule retention occurred in any pediatric patient. Conclusion Capsule endoscopy in children is noninvasive, rapid and simple, which can improve the diagnostic rate of small intestinal diseases in children, and can be further promoted in pediatric patients.