结肠途径经内镜肠道植管术治疗溃疡性结肠炎的方法学研究  

Methodology of colonic transendoscopic enteral tubing for ulcerative colitis

作　　者：温泉 龙楚彦 崔伯塔[1] 张洁 张发明[1] Wen Quan;Long Chuyan;Cui bota;Zhang Jie;Zhang Faming(Medical Center for Digestive Diseases,Key Lab of Holistic Integrative Enterology,The Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,China)

机构地区：[1]南京医科大学第二附属医院消化医学中心,南京医科大学整合肠病学重点实验室,210011

出　　处：《中华炎性肠病杂志（中英文）》2019年第3期222-226,共5页Chinese Journal of Inflammatory Bowel Diseases

基　　金：江苏省十三五科教强卫工程创新团队/领军人才项目(张发明).

摘　　要：目的 评价结肠途径经内镜肠道植管术(TET)用于溃疡性结肠炎(UC)患者粪菌移植(FMT)和肠道给药的方法,并分析影响结肠TET管保留时间的可能因素.方法 纳入南京医科大学第二附属医院2015年10月至2019年3月接受结肠TET用于FMT和/或结肠给药的全部UC患者.记录TET植管时间、成功率、不良事件、患者满意度、TET管保留时间及对其影响因素进行分析.结果共150例UC患者接受结肠TET,126例(84.0%)用于FMT联合结肠给药,18例(12.0%)用于FMT,5例(3.3%)用于结肠给药.TET平均植管用时(9.6±2.7)min.TET植管成功率为100%.在TET管自然脱落的122例患者中,TET管保留时间中位数为9(7.0,11.0)d.使用大组织夹的患者中,随着使用夹数目在2~4个范围内增加,TET管保留时间延长(P=0.002).夹数目相同时(n=3或4),大组织夹组的留管时间中位数长于小组织夹组(P<0.05).组织夹类型(OR=0.085,95%CI:0.020~0.354,P=0.001)及组织夹个数(OR=0.509,95%CI:0.294~0.881,P=0.016)影响TET管保留时间.植管术中及术后未发生严重不良事件.患者对结肠TET满意度为96.0%(144/150).结论 结肠TET用于UC患者结肠途径重复FMT和肠内给药安全可行,TET管保留时间与组织夹类型、个数相关.Objective To evaluate the method of colonic transendoscopic enteral tubing(TET)for ulcerative colitis(UC)as a new colonic interventional delivering in fecal microbiota transplantation(FMT)or medications,and to analyze influencing factors for retention time of TET tube.Methods UC patients who underwent colonic TET for FMT and/or colonic administration in the Second Affiliated Hospital of Nanjing Medical University from October 2015 to March 2019 were prospectively enrolled.The TET method,procedure time,success rate,adverse events and satisfaction degree,retention time of TET tube were recorded and their influencing factors were analyzed.Results A total of 150 UC patients underwent colonic TET.The TET tubes were used in 126 patients(84.0%)for FMT and medication,18 patients(12.0%)for FMT,and 5 patients(3.3%)for medication.The mean TET procedure time was(9.6±2.7)min.The success rate of TET procedure was 100%.The median retention time of TET tube was 9(7.0,11.0)d in 122 patients with the tube falling out naturally.In patients with large endoscopic clips,the retention time of TET tube was significantly prolonged with the increased number of large clips(n=2~4,P=0.002).The retention time of TET tube in the large clip group was longer than that in the small clip group,when the number of endoscopic clips used was the same(n=3 or 4,P<0.05).The type(OR=0.085,95%CI:0.020 to 0.354,P=0.001)and number(OR=0.509,95%CI:0.294 to 0.881,P=0.016)of endoscopic clips were the influencing factors for the retention time of tube.No severe adverse event was observed during and after TET.The satisfaction degree on colonic TET was 96.0%(144/150)in all the patients.Conclusions Colonic TET as a colonic delivering of multiple FMT and frequent colonic medication administration for UC patients is safe and feasible.The retention time of TET tube is related to the type and number of endoscopic clip.

关 键 词：经内镜肠道植管术 粪菌移植 溃疡性结肠炎 肠镜 灌肠 

分 类 号：R5[医药卫生—内科学]