婴幼儿结肠镜检查223例临床特点及病因分析  

Clinical characteristics and etiology analysis of 223 children undergoing colonoscopy

作　　者：龚舒[1] 李中跃[1] 詹学[1] 胡华建[1] 王玉婷[1] 陈静[1] 

机构地区：[1]重庆医科大学附属儿童医院消化内科,400014

出　　处：《中华实用儿科临床杂志》2016年第19期1456-1459,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：重庆市卫生局重点项目（2013-1-023）

摘　　要：目的探讨婴幼儿结肠镜检查的病因和临床特点，提高对相关疾病及其内镜下表现的认识。方法回顾性分析2010年7月至2014年12月在重庆医科大学附属儿童医院消化内科接受结肠镜检查且年龄≤3岁的223例患儿的临床及内镜资料。其中男148例，女75例；年龄26 d～3岁，〈6个月41例，6～12个月68例，1～3岁114例。结果223例患儿在静脉复合麻醉下采用单人或双人操作手法，共完成235例次结肠镜检查，其中221例次顺利到达回盲部（回肠末端29例次，回盲部192例次），完成率94.0%。主要临床表现为血便（124例，55.6%）、迁延性/慢性腹泻（55例，24.7%）、慢性腹泻合并血便（22例，9.5%），其他原因（22例，9.5%）。最终阳性诊断率96.4%（215/223例）。前5位病因依次为食物蛋白性直肠结肠炎（78/223例，35.0%），肠息肉（50/223例，22.4%），大肠炎（29/223例，13.0%），抗生素相关性腹泻（19/223例，8.5%），食物蛋白性直肠结肠炎合并抗生素相关性腹泻（10/223例，4.5%）。结论结肠镜检查对婴幼儿便血、慢性腹泻的相关病因具有重要的诊断价值。食物蛋白性直肠结肠炎、肠息肉为引起婴幼儿便血、慢性腹泻的主要病因，与抗生素相关的腹泻及便血应引起足够的重视。结肠镜联合病理组织活检在肠结核、肠淋巴管扩张症、贝赫切特综合征、原发性免疫缺陷病等少见疾病的诊断中具有一定价值。Objective To investigate the clinical characteristics and etiology in infants undergoing colonoscopy in order to improve the understandings of lower gastrointestinal tract diseases and their endoscopic manifestations. Methods The clinical and endoscopic data of the infants aged ≤3 years old who underwent conoloscopy at the Department of Gastroenterology, Children＇s Hospital of Chongqing Medical University, from July 2010 to December 2014, were retrospectively analyzed. A total of 223 children were included, 148 male and 75 female. The age range was from 26 d to 3 years old（ 〈6 months：41 cases;6 - 12 months：68 cases;1 -3 years old：l14 eases）. Results A total of 235 colonoseopies were performed under deep sedation by single or double manipulators. Cecal intubation was successful in 192 colonoscopies and terminal ileal intubation was completed in 29 colonoscopies ,with a high success rate of 94.0% （221/235 eolonoscopies）. The main symptoms included hematochezia（ 124 eases ,55.6% ）, persistent/chronic diarrhea （55 cases,24.7% ） ,hematochezia with chronic diarrhea（22 cases,9.5% ） ,and others（22 cases,9.5% ）. Of the 223 patients, clear diagnosis were established for 215 children （96.4%）, with food protein -induced proctocolitis （FP1PC） （ 78/223 eases, 35.0% ）, colonic polyps （ 50/223 cases, 22.4% ）, colitis （ 29/223 cases, 13.0% ）, antibiotic associa- ted diarrhea （AAD） （ 19/223 cases,8.5% ）, FPIPC with AAD （ 10/223 cases,4.5% ）. Conclusions Colonoscopy serves as a very important tool for the accurate diagnosis of lower gastrointestinal diseases with hematochezia and/or chronic diarrhea. FPIPC and colonic polyps are the most common causes for hematochezia and/or chronic diarrhea. AAD may be another important cause of chronic diarrhea and bloody stool in infants. Moreover, ghe application of colonoscopy in combination with histopathology can also play an important role in the diagnosis of some rare diseases, such as intestinal tuberculosis ,primary inte

关 键 词：婴幼儿 结肠镜检查 便血 慢性腹泻 

分 类 号：R725.7[医药卫生—儿科]