双气囊小肠镜对小儿下消化道出血的诊断及治疗作用  

Diagnostic and therapeutic values of double-balloon enteroscopy for lower gastrointestinal hemorrhage in children

作　　者：戚士芹 未德成 吕成超 杨涌 黄河 

机构地区：[1]安徽省儿童医院小儿普外科,合肥230053

出　　处：《中华小儿外科杂志》2015年第8期622-625,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的报告应用双气囊小肠镜（double—balloon enteroscopy，DBE）于小儿下消化道出血的结果及我们在诊断和治疗上的经验。方法2011年8月至2014年9月对26例大量暗红色血便患儿，控制出血症状、排除内科疾病后，DBE经肛门进镜，利用气囊的反复充气、放气，进镜小肠，寻及病变后如为Meckel憩室、肿瘤，摆动镜头光源至脐环下经脐环切开，如不能至脐环下则经腹壁小切口，提出病变予切除、肠吻合；如为息肉予圈套后电凝切除。结果诊断Meckel憩室14例，均成功微创手术；息肉病3例，均予电凝切除所见息肉；淋巴瘤2例，均成功微创手术；1例1岁患儿因镜身过回盲瓣困难而进镜失败，随访14个月未见再出血；6例阴性检查结果，其中5例经3～35个月随访未见再出血，1例随访7个月后再发下消化道出血，经腹腔镜探查仍阴性，继随访观察中。无围检查、手术期并发症。结论DBE对小儿下消化道出血不仅具有诊断价值，更能达到微创治疗的效果。Objective To report our experiences of applying double-balloon enteroscopy （DBE） for lower gastrointestinal hemorrhage in children. Methods From August 2011 to September 2014, retrograde DBE was performed on 26 pediatric patients with bloody diarrhea. With alternate inflation and deflation of balloons at the tip of endoscope and overtube, enteroscope was inserted into intestine. When a Meckel diverticulum or tumor was identified, enteroscopic light source was swung to umbilicus, a small incision was made at umbilicus and intestine indicated by enteroscopic light source was extracted for lesion removal and intestinal anastomosis. When light source could not be swung, a 2 cm incision was made on abdominal wall. And the subsequent steps were similar. Electrosurgical snare resection was performed for polyps. Results Meckel diverticulum （n = 14） and lymphoma （n = 2） underwent mini-invasive procedures. Polyps （n = 3） had electrosurgical extirpation. One patient aged 1 year failed DBE examination since enteroscope could not pass through ileocecal valve. And there was no recurrence of bloody diarrhea during the follow-ups. There were 6 patients with negative results. One of them had recurrent bloody diarrhea and a negative laparoscopic exam and the remainder had no recurrent bloody diarrhea during the follow-ups. No complications were observed during examinations or operative period. Conclusions With great diagnostic values, DEB is also mini- invasively efficacious for lower gastrointestinal hemorrhage in children.

关 键 词：双气囊小肠镜 下胃肠道 儿童 

分 类 号：R725.7[医药卫生—儿科]