目的 探讨多层螺旋CT（MSCT）在肠道Crohn病（CD）诊断中的应用价值。 方法 回顾性分析2009年2月－2012年2月经综合方法确诊为CD的41例患者的MSCT表现，分析病变肠管的部位、肠壁的厚度和增强后病变肠壁的强化程度及并发症。 结果 41例中，患病肠段多节段性受累36例（87.8%），单独小肠受累16例（39.0%），小肠和结肠同时受累23例（56.2%），单独结肠受累2例（4.8%），回肠末段受累36例（87.8%），盲肠或升结肠受累22例（53.7%）。41例肠壁均见不同程度的强化及环形增厚；28例（68.3%）表现肠壁分层；23例（56.1%）表现为系膜纤维脂肪增生、蜂窝织炎，16例（39.0%）系膜血管增多，呈“梳样征”，20例（48.8%）伴有系膜及腹膜后淋巴结肿大；6例（14.6%）并发不全肠梗阻，并发瘘管穿孔1例（2.4%）。 结论 MSCT可同时显示CD的小肠和结肠病变，对肠壁病变及肠腔外并发症的显示以及在判断病变活动性方面有独特的优越性，对指导临床治疗具有重要意义。
【Abstract】Objective To investigate the value of laparoscopy in the diagnosis and treatment of small bowel diseases.Methods Data of thirtythree cases of small bowel diseases receiving laparoscopy in this hospital from May 2000 to February 2004 were analyzed retrospectively. Results All cases underwent laparoscopy successfully and no complication was observed. The mean operative time was 65 min.The mean intraoperative blood loss was 30 ml. Postoperative pain was mild. Flatus and feces were passed about 32 hours after treatment and the mean postoperative hospital stay was 7 days. The pathologic examination showed: 18 benign and 6 lowgrade malignant stromal tumors, 5 Meckel’s diverticula and 4 NonHodgkin’s lymphomas. No recurrence occurred in 33 cases during the followup for 10 to 36 months.Conclusion Laparoscopy is a very useful and minimally invasive technique in the diagnosis and treatment of small bowel diseases. It is simple, safe, effective and worthy of be clinically applied.
【摘要】 目的 探讨胶囊内镜对小肠疾病的诊断价值及顺应性和安全性。 方法 分析2009年4月-2010年3月对35例疑有小肠疾病者行胶囊内镜检查的临床资料。 结果 35例中发现小肠病变26例 （74.3%），包括血管畸形9例，间质瘤1例，息肉2例，小溃疡 1例，非特异性炎症 11例，寄生虫2例，其中 4例患者同时存在两种病变。所获取的图像质量良好。胶囊胃内运行平均时间为 62 min（5～460 min），小肠运行时间为 347 min（103～538 min），平均到达盲肠时间为384 min （120～540 min），平均记录时间为547 min（299～605 min），平均获取照片数为54 766张，胶囊排出体外时间平均为33 h（10～120 h）。受检者顺应性良好，无任何并发症发生。 结论 胶囊内镜是一种对小肠疾病具有较高的检出能力；其安全性高、顺应性好 。【Abstract】 Objective To investigate the diagnostic value of capsule endoscope for small intestine diseases, and to evaluate the compliance and security of capsule endoscopy. Methods The clinical data of 35 patients who underwent capsule endoscopy due to small bowel diseases between April 2009 and March 2010 were retrospectively analyzed. Results In the 35 patients, 26 (74.3%) had intestine diseases including vascular malformation in nine, interstitialoma in one, polyp in two, aphtha in one, non-specific inflammation in 11 and parasite in two; 4 patients had two lesions simultaneously. The quality of the obtained images was good. The average running time of the capsules in the stomach ranged from five to 460 minutes with an average time of 62 minutes. The running time of the capsules in the small intestine ranged from 103 to 538 minutes with an average of 347 minutes. The running time of the capsules arriving at the cecum ranged from 103 to 538 minutes with an average of 347 minutes. The time of the capsules egested out ranged from 10 to 120 hours with an average of 33 hours. The recording time ranged from 299 to 605 minuets with an average of 547 minutes. The mean acquired images were 54 766 pieces, The patients had good compliance, and none had any complications. Conclusion The capsule endoscopy had high security and good compliance. It has high detectivity in diagnosing small intestine diseases.
【摘要】 目的 探讨不同回声类型超声造影剂在胃肠疾病诊断中的价值。 方法 采用“胃窗声学造影剂”充盈检查法，用凸阵3.5 MHz探头，对2009年3-8月366名受检者行经腹壁超声检查。受检者随机分为两组：饮水者为A组，饮有回声造影剂者为B组。 结果 选择性地应用合适的造影剂，能有效地提高对胃肠疾病的超声诊断水平。【Abstract】 Objective To evaluate the application of contrast agents with different echogenic in the diseases of stomach and intestine. Methods Totally, 366 patients were included in the study from March to August 2009. Patients were randomly divided into two groups： group A (oral acoustic contrast agent) and group B (water). Contrast-enhanced Doppler sonography was performed with 3.5 MHz abdomen probe. Results Contrast agent with anechoic was good for showing iso-echoic and hyperechoic tissue.Hyperechoic contrast agent was better for showing hypoechoic changes according to its long sitting-time in stomach. Conclusion Contrast enhanced ultrasound has practical value in diagnosis of the diseases of stomach and intestine.
ObjectiveCapsule endoscopy (CE) has been widely used in the diagnosis of small bowel disease (SBD) in the world. To bring CE into the national health insurance directory, and intensify its popularization in primary hospitals, the government needs high quality health technology assessment (HTA) evidence for decision making. This study was aimed to comprehensively evaluate the effectiveness, safety, applicability and economics of CE in the diagnosis of SBD based on global review, to providing the best currently-available evidence for decision making. MethodsWe electronically searched The Cochrane Library (Issue 8, September 2013), PubMed, EMbase, INAHTA, VIP, CBM, CNKI and WanFang Data. We screened studies, extracted data, and evaluated quality independently, according to inclusion and exclusion criteria; and then we made final conclusion after comprehensive analysis. ResultsWe finally included 4 HTAs, 11 systematic reviews (SRs)/ Meta-analyses, 2 randomized controlled trials (RCTs), 5 guidelines, and 10 economics studies for assessment. The results of HTAs, SRs/ meta-analyses and RCTs all showed that, the disease detection rate of CE was higher than that of many other traditional technologies, and that the main adverse event for CE was retention (0.7% to 3.0%), which were consistent with those of the guidelines' recommendations. Besides, the comprehensive results of economics studies showed the superiority of CE compared with other technologies. As the first choice, CE could significantly decrease potential costs, especially when used in outpatients. Conclusiona) Compared with similar technologies, CE indeed has advantages in diagnostic yield, safety and potential costs in the diagnosis of SBD. However, its application has certain limitations, which still needs to be verified by more high quality evidence about CE diagnosis accuracy. b) It is sug gested that, when the government approves the introduction of CE to hospitals, many factors must be considered, such as local disease burden, clinical demands, ability to pay, and staff configuration. At the same time, it is necessary to standardize training for medical technicians, to reduce economic loss caused by poor technical abilities of medicaltechnicians.
ObjectivesTo investigate the efficacy and safety of Hou Gu Mi Xi (HGMX) in patients with nonorganic gastrointestinal disorders (NOGD) from the aspect of dietary therapy.MethodsA randomized, double-blind, parallel, placebo-controlled trial was performed. Patients with NOGD and spleen qi deficiency (SQD) syndrome were randomly assigned into HGMX or placebo group. Each received 30 g/day HGMX or placebo for one year. The outcomes included SQD scores, body weight, body mass index (BMI), gastrin-17, and adverse events (AEs) between HGMX and placebo groups, or subgroups divided by NOGD type or helicobacter pylori (Hp) infection, at the 0th, 2nd, 4th, 8th, 26th, or 52nd weeks’ follow-up.ResultsThe reduction of SQD scale score was found in the HGMX group compared with the placebo group at 4th week (MD=−9.40, 95%CI −18.53 to −0.27, P=0.044), 8th week (MD=−10.07, 95%CI −19.66 to −0.48, P=0.04), 26th week (MD=−12.45, 95%CI −22.31 to −2.59, P=0.014) and 52th week (MD=−17.25, 95%CI −28.53 to −5.97, P=0.003), respectively. In the subgroup analyses, HGMX showed significant efficacy in Hp-negative patients with the detailed reduction of SQD scale score being (MD=−15.20, 95%CI −28.16 to −2.24, P=0.022), (MD=−17.91, 95%CI −31.22 to −4.59, P=0.009) and (MD=−20.38, 95%CI −35.43 to −5.32, P=0.008) at the 8th, 26th and 52nd week, respectively, and in patients with chronic nonatrophic gastritis with the detailed reduction being (MD=−13.02, 95%CI −24.75 to −1.29, P=0.03), (MD=−12.43, 95%CI −24.36 to −0.5, P=0.041) and (MD=−15.90, 95%CI −30.72 to −1.08, P=0.036) at the 2nd, 26th and 52nd week, respectively, and in patients with functional gastrointestinal disease with the reduction being (MD=−18.22, 95%CI −35.75 to −0.69, P=0.042) at the 52nd week. However, no significant efficacy was found in Hp-positive patient at any time. HGMX was not associated with changes in weight, BMI, or gastrin-17. No AEs were reported in the HGMX group.ConclusionsHGMX improves SQD symptoms in patients with NOGD, especially Hp-negative patients, and has a good safety profile.
ObjectiveTo understand the prevalence of anorectal diseases in the elderly in the community, and to evaluate the role of electronic rectosigmoidoscope in the screening of anorectal diseases.MethodThe resident population aged 60–74 in the Xichang’an Street Area of Xicheng District of Beijing were collected to complete the initial screening by filling in the risk factor assessment questionnaire, and who were classified as the high-risk with positive initial screening were admitted to the diagnostic re-screening by electronic rectosigmoidoscope.ResultsThere were 4 782 screening subjects, while 4 347 people actually participated in the initial screening, and 2 997 people were positive (positive rate was 68.9%). Among them, 2 312 participated in the electronic rectosigmoidoscope screening, and the compliance rate was 77.1%. A total of 2 275 patients with various anorectal diseases were detected by electronic rectosigmoidoscope, 1 311 (56.7%) of whom were hemorrhoids, 458 (19.8%) were rectal polyps, 154 (6.7%) were anal papillary hypertrophy, 147 (6.4%) were proctitis, 103 (4.4%) were anal fissure, 52 (2.2%) were anal fistula , 33 (1.4%) were rectal melanoma , and 17 (0.7%) were suspected rectal cancer. The detection rates of rectal polyps, proctitis, and anal fistula in the men were higher than those in the women (P<0.05), while the detection rates of hemorrhoids, anal papilla hypertrophy, anal fissure, and rectal melanosis in the women were higher than those in the men (P<0.05).ConclusionsAs a screening tool, electronic rectosigmoidoscope has the characteristics of simple operation, good compliance of the subject, and high compliance rate for re-screening. It is suitable for large-scale screening of anorectal diseases for elderly residents in the community.
ObjectiveTo systematically review the diagnostic value of capsule endoscopy and enteroscopy in small intestinal diseases.MethodsPubMed, The Cochrane Library, Web of Science, CNKI, WanFang Data, and VIP databases were electronically searched to collect studies on the diagnosis of intestinal diseases by capsule endoscopy and enteroscopy from inception to August 31st, 2020. Two reviewers independently screened literature, extracted data and assessed risk bias of included studies. Meta-analysis was then performed by using RevMan 5.3 and Meta-DiSc software.ResultsA total of 20 studies were included. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio for capsule endoscopy were 0.86 (95%CI 0.83 to 0.87), 0.81 (95%CI 0.78 to 0.84), 117.07 (95%CI 37.98 to 360.92), 7.20 (95%CI 2.81 to 18.45), 0.11 (95%CI 0.06 to 0.21), and those for enteroscopy were 0.89 (95%CI 0.87 to 0.90), 0.91 (95%CI 0.89 to 0.93), 196.99 (95%CI 72.63 to 534.26), 13.26 (95%CI 5.00 to 35.14), 0.12 (95%CI 0.07 to 0.21). The areas under the working characteristic curve (SROC) of capsule endoscopy and enteroscopy were 0.9692 and 0.9783, respectively.ConclusionsBoth capsule endoscopy and enteroscopy have high specificity and sensitivity in the diagnosis of small intestinal diseases, and enteroscopy has higher clinical value in the diagnosis of some small intestinal diseases than capsule endoscopy. Due to limited quantity and quality of the included studies, the above conclusions are required to be verified by more high-quality studies.