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  本文選題：系線膠囊內(nèi)鏡　切入點：胃鏡　出處：《福建醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：【目的】 探討系線膠囊內(nèi)鏡對急性上消化道出血診斷的價值、可行性、安全性及患者的耐受程度。 【材料與方法】 選取于2013年6月至2013年12月就診我院的擬診上消化道出血的患者，均以嘔血和/或黑便等癥狀入院；對每名患者進行詳細病歷資料采集，對其基本資料、現(xiàn)病史、既往史、系線膠囊內(nèi)鏡檢查和胃鏡檢查距最后一次嘔血和/或黑便的時間等進行詳細記錄。對小腸膠進行系線改良，，并對入選病例行系線膠囊內(nèi)鏡檢查，待生命征平穩(wěn)后行胃鏡檢查，比較其在是否上消化道出血診斷、可能出血病灶的診斷、不良反應(yīng)、不適評分、及是否愿意重復(fù)系線膠囊內(nèi)鏡檢查等方面進行比較，并分析是否有統(tǒng)計學意義上的差異。 【結(jié)果】 符合入選標準的病人共40例，其中男性26例，女性14例，年齡在54.8±20.4（20-80歲）歲；行系線膠囊內(nèi)鏡檢查的有40例，行胃鏡檢查的有36例。系線膠囊內(nèi)鏡檢查距最后一次嘔血和/或黑便的平均時間為31.9±21.0h。系線膠囊內(nèi)鏡下見陽性結(jié)果有29例，其中2例為上消化道咖啡樣出血，1例為活動性出血，2例為血痂，24例檢出可能出血病灶：其中12例為上消化道潰瘍，5例為粘膜糜爛出血，2例為胃惡性腫瘤，5例為食管靜脈曲張和/或門脈高壓性胃��；而檢查為陰性的有11例。胃鏡檢查距最后一次嘔血和/或黑便的時間為69.7±22.5h。胃鏡下陽性結(jié)果有30例，其中1例為活動性出血，1例為血痂，28例檢出可能出血病灶：其中19例為上消化道潰瘍，3例為粘膜糜爛出血，2例為胃惡性腫瘤，4例為食管靜脈曲張出血/或門脈高壓性胃病；而檢查為陰性的有6例。系線膠囊內(nèi)鏡對上消化道出血陽性結(jié)果檢出率為72.5%，胃鏡的檢出率為83.3%，差異有統(tǒng)計學意義；以胃鏡為診斷標準，系線膠囊檢查的敏感度為93.3%，特異度為83.3%，陽性預(yù)測值為96.6%，陰性預(yù)測值為83.3%。在40例行系線膠囊內(nèi)鏡檢查的患者中有2例（5.0%）分別出現(xiàn)咽部及賁門粘膜充血糜爛出血，均可自行好轉(zhuǎn)；對系線膠囊內(nèi)鏡檢查的不適評分的中位數(shù)為5.0±2.8分（2-10，以胃鏡檢查不適為10分為標準）；愿意重復(fù)系線膠囊檢查者達92.5%。 【結(jié)論】 系線膠囊內(nèi)鏡在急性上消化道出血診斷上，有效性、安全性高，耐受良好；可應(yīng)用于急性上消化道出血的早期診斷，是急診胃鏡檢查的很好補充手段。
[Abstract]:[purpose]. Objective: to evaluate the value, feasibility, safety and tolerance of suture capsule endoscopy in the diagnosis of acute upper gastrointestinal hemorrhage. [materials and methods]. From June 2013 to December 2013, all the patients with upper gastrointestinal bleeding were admitted to hospital with hematemesis and / or black stool, and each patient was collected the detailed medical records, and the basic data, present medical history, past history, and so on, were collected. The time of endoscopy and gastroscopy from the last hematemesis and / or black stool were recorded in detail. To compare the diagnosis of upper gastrointestinal hemorrhage, the diagnosis of possible hemorrhage focus, adverse reactions, discomfort score, and whether they are willing to repeat the capsule endoscopy, and to analyze whether there are statistical differences. [results]. A total of 40 patients met the inclusion criteria, including 26 males and 14 females aged from 54.8 鹵20.4 to 80 years old. 36 cases underwent gastroscopy. The average time from the last hematemesis and / or black stool was 31.9 鹵21.0 hours. Of them, 2 cases were coffee-like hemorrhage of upper digestive tract, 1 case was active hemorrhage, 2 cases were blood scab, 24 cases were possible bleeding focus: 12 cases were upper digestive tract ulcer, 5 cases were mucosal erosion, hemorrhage 2 cases were gastric malignant tumor, 5 cases were fodder. Varicose vein and / or portal hypertensive gastropathy; However, 11 cases were negative. The time between gastroscopy and the last hematemesis and / or black stool was 69.7 鹵22.5h.There were 30 cases with positive results under gastroscopy. Among them, 1 case was active hemorrhage and 1 case was blood scab. Among them, 19 cases were upper digestive tract ulcer, 3 cases were mucosal erosion, 2 cases were gastric malignant tumor, 4 cases were esophageal variceal bleeding or portal hypertensive gastropathy. The positive rate of upper gastrointestinal bleeding was 72.5 and 83.3 respectively, and the difference was statistically significant. The sensitivity, specificity, positive predictive value and negative predictive value were 93.3g, 83.3, 96.6and 83.3respectively. The median of the discomfort score of endoscopy was 5.0 鹵2.8 minutes 2-10, and that of gastroscopy was 10, and that of those who were willing to repeat the examination of thread capsule was 92.5%. [conclusion]. The capsule endoscopy is effective, safe and well tolerated in the diagnosis of acute upper gastrointestinal hemorrhage. It can be used in the early diagnosis of acute upper gastrointestinal hemorrhage and is a good supplementary method for emergency gastroscopy.
【學位授予單位】：福建醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R573.2

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