摘要目的 探讨双气囊小肠镜在儿童中的使用方法、安全性,评价其临床价值,及其在儿科应用的困难.方法 本组22例,为2006年12月至2009年10月在我院消化科住院,因为胃肠道出血、再发性腹痛、低蛋白血症等原因接受双气囊小肠镜检查患儿,年龄4～16岁,所有操作均在麻醉下进行,患儿均取仰卧位,利用双气囊小肠独有的外套管、肠镜前端的双气囊交替充气、放气,经幽门或回盲瓣进入小肠,小肠镜和外套管不断地前进和退镜,将小肠缩短到内窥镜可以检查的范围.在检查过程中记录检查范围、病变,患儿耐受性等.结果 本组共接受25例次双气囊小肠镜检查,其中3例次顺行进镜,22例次逆行进镜;3例同时经口和经肛门检查.18例发现病灶,病变检出率为81.82%.所有操作均在麻醉下进行,包括麻醉和术后恢复,一般需要90～120 min.本组均未发生吸入性肺炎、肠道穿孔、出血等严重并发症.通过双气囊小肠镜,诊断克罗恩病7例,Meckel憩室并溃疡3例,空肠、横结肠息肉1例,小肠淋巴管扩张症1例、阿米巴肠炎1例、小肠炎出血3例,非特异性回肠炎2例.本组均耐受检查,未发现严重不良反应和并发症.结论 双气囊小肠镜对小肠疾病有良好的检出率,儿童患者能耐受检查,在儿科患者中应用是有效和可行的.但双气囊小肠镜在儿科的推广应用仍受到一些因素的制约.

abstractsObjective Double balloon enteroscopy (DBE) is already an established modality of investigation in adults though its use in children has not yet been widely practiced. This study aimed to explore the method and safety of pediatric DBE and to evaluate its clinical value and applicability in the pediatric age group. Method During the period from December, 2006 to October, 2009 DBE was performed on a total of 22 patients (age 4 to 16 years) at the hospital. The indications included: gastrointestinal bleeding, chronic abdominal pain, suspected Crohn's disease and hypoalbuminemia. With the aid of a specially designed overtube, and the alternate inflation and deflation of the balloons at the tip of the endoscope and overtube, the enteroscope was advanced in the small intestine either antegrade or retrograde by telescoping the small intestine along its way. The range of intestine covered, pathology encountered, and tolerability of the examination by the subjects were recorded during the procedure. Result A total of 25 DBE's were performed: antegrade in 3 and retrograde in 22. In 3 patients, both antegrade and retrograde enteroscopy was performed. All the procedures were performed under anesthesia Inclusive of anesthesia and post-procedure recovery, each procedure took approximately 90 to 120 minutes. The pathology was identified in 18 out of 22 patients (81. 82% ), including: 7 cases of Crohn's disease, 3 of Meckel's divertieulum, combined ileal and colonic polyp in one, intestinal lymphangiectasis in one, amebiasis in one, small intestinal hemorrhage in 3 and non-specific ileitis in 2. No serious complications such as aspiration pneumonia, perforation or hemorrhage occurred and all patients tolerated the procedures well. Conclusion DBE is a useful and feasible procedure in the pediatric patients. Young patients can tolerate the procedure well.