疑似小腸出血患者雙氣囊小腸鏡全小腸對(duì)接檢查的臨床研究

背景：雙氣囊小腸鏡（DBE）全小腸對(duì)接檢查在疑似小腸出血（SSBB）患者診治中發(fā)揮重要作用。目的：調(diào)查SSBB患者DBE全小腸對(duì)接檢查情況并分析其臨床特征。方法：納入2018年6月—2023年4月安徽省蚌埠市第三人民醫(yī)院和安徽醫(yī)科大學(xué)第一附屬醫(yī)院需行DBE對(duì)接檢查的94例SSBB患者，并分析其臨床特征。結(jié)果：共54例SSBB患者完成DBE全小腸對(duì)接檢查，對(duì)接成功率為57.4%。因發(fā)現(xiàn)出血病變而中止對(duì)接檢查者10例（10.6%），腸腔狹窄而中止對(duì)接檢查者5例（5.3%），操作中出現(xiàn)進(jìn)鏡困難而中止對(duì)接檢查者25例（26.5%）。SSBB患者DBE全小腸對(duì)接率與不同對(duì)接時(shí)間、醫(yī)師既往小腸鏡操作例數(shù)有關(guān)（Plt;0.05），而與患者性別、年齡、出血表現(xiàn)形式、煙酒嗜好、營(yíng)養(yǎng)風(fēng)險(xiǎn)、腹部手術(shù)史、肛周病變、自身免疫病、術(shù)前貧血、術(shù)前白蛋白水平、進(jìn)鏡途徑均無(wú)關(guān)（Pgt;0.05）。ROC曲線結(jié)果顯示，先進(jìn)鏡深度的截?cái)嘀禐?85 cm時(shí)，評(píng)估SSBB患者完成全小腸對(duì)接檢查的敏感性為72.2%，特異性為77.5%，曲線下面積為0.800（95% CI： 0.705～0.875，Plt;0.001）。結(jié)論：SSBB患者DBE全小腸對(duì)接率與不同對(duì)接時(shí)間、醫(yī)師既往小腸鏡操作例數(shù)有關(guān)。先進(jìn)鏡深度達(dá)到385 cm以上，80%的SSBB患者有望實(shí)現(xiàn)全小腸對(duì)接檢查。

關(guān)鍵詞 疑似小腸出血； 胃腸出血； 雙氣囊小腸鏡； ROC曲線

Clinical Study on Combined Double?balloon Enteroscopy in Patients With Suspected Small Bowel Bleeding ZHANG Shuang1， ZHANG Pengyue2， FENG Yan1， JIANG Yong1， WANG Yalei2， MEI Qiao2， HU Naizhong2." 1Department of Gastroenterology， the Third People's Hospital of Bengbu， Bengbu， Anhui Province （233000）; 2Department of Gastroenterology， the First Affiliated Hospital of Anhui Medical University， Hefei

Correspondence to： MEI Qiao， Email： meiqiaomq@hotmail.com

Background： Combined double?balloon enteroscopy （DBE） plays an important role in the diagnosis and treatment of patients with suspected small bowel bleeding （SSBB）. Aims： To investigate the performance of combined DBE in patients with SSBB and their clinical features. Methods： A total of 94 patients with SSBB underwent combined DBE from June 2018 to April 2023 at the Third People's Hospital of Bengbu and the First Affiliated Hospital of Anhui Medical University were enrolled， and the clinical features were analyzed. Results： Fifty?four SSBB patients completed the combined DBE， and the combination rate was 57.4%. Ten patients （10.6%） stopped combined DBE due to discovery of bleeding lesions. Five patients （5.3%） stopped combined DBE due to intestinal stenosis. Twenty?five patients （26.5%） stopped combined DBE due to difficulty in insertion. Combined DBE rate in SSBB patients was correlated with the combination time and the number of previous DBE for endoscopists （Plt;0.05）， but not the gender， age， bleeding manifestations， tobacco smoking and alcohol drinking， nutritional risk， abdominal operation history， perianal lesions， autoimmune diseases， preoperative anemia， preoperative albumin level， and enteroscopy approach （Pgt;0.05）. ROC curve showed that when the cut?off value of first insertion depth was 385 cm， the sensitivity and specificity for successful combined DBE in SSBB patients were 72.2% and 77.5%， respectively， and the area under ROC curve was 0.800 （95% CI： 0.705?0.875， Plt;0.001）. Conclusions： The combined DBE rate in SSBB patients is correlated with the combination time and the number of previous DBE for endoscopists. 80% of the SSBB patients are expected to complete the combined DBE when the first insertion depth is greater than 385 cm.

Key words Suspected Small Bowel Bleeding; Gastrointestinal Hemorrhage; Double Balloon Enteroscopy;

ROC Curve

小腸出血占消化道出血的5%～10%，一直是消化系統(tǒng)疾病診治的難點(diǎn)之一[1]。鑒于近年膠囊內(nèi)鏡（capsule endoscopy， CE）、器械輔助式小腸鏡（device?assisted enteroscopy， DAE）和放射影像學(xué)在小腸成像方面的進(jìn)步，越來(lái)越多的疑似小腸出血（suspected small bowel bleeding， SSBB）患者得以得到早期診斷和及時(shí)治療[2?3]。目前國(guó)內(nèi)廣泛應(yīng)用的DAE主要是氣囊輔助式小腸鏡如雙氣囊小腸鏡（double?balloon enteroscopy， DBE）。DBE對(duì)不明原因消化道出血（obscure gastrointestinal bleeding， OGIB）的診斷價(jià)值已得到廣泛肯定，2018年《中國(guó)小腸鏡臨床應(yīng)用指南》指出小腸鏡標(biāo)記后的對(duì)接率為評(píng)價(jià)小腸鏡檢查質(zhì)量的“金標(biāo)準(zhǔn)”，建議廣泛開(kāi)展[4]。……