摘要目的 评价双气囊小肠镜(DBE)在不明原因消化道出血病因诊断中的价值,对DBE确诊的不明原因消化道出血手术治疗病例进行卫生经济学评价.方法 114例常规检查不能明确病因的消化道出血患者行双气囊小肠镜检查,以活检组织和手术大体标本的病理学结果为金标准,评价DBE在不明原因消化道出血中的诊断价值;并进行卫生经济学评价.结果 DBE诊断不明原因消化道出血敏感度为85.86％,特异度为63.63％,准确度为81.57％,阳性似然比为2.36,阴性似然比为0.22.DBE检查每多诊断出1例小肠病变获得的净效益为4 802.2元.双气囊小肠镜指导下OGIB手 术治疗组与未行小肠镜检查即行手术治疗组相比的总住院天数[(27.2±11.8)d比(16.4±5.3)d,P＜0.05]、住院总费用[(35 690.2±3 466.5)元比(19 409.3±9 253.2)元,P＜0.05]、住院药费[(17 805.8±2 145.5)元比(9 133.0±4 664.9)元,P＜0.05]均明显减少.结论 双气囊小肠镜检查对不明原因消化道出血病因诊断具有重要临床价值.分析表明双气囊小肠镜在指导不明原因消化道 出血手术治疗中具有重要临床意义、卫生经济学意义和良好的社会效益.

abstractsObjective To evaluate the double-balloon enteroscopy(DBE) for obscure gastrointestinal bleeding(OGIB) and evaluate the health economics under the guidance of DBE for surgical treatment of obscure gastrointestinal bleeding.Methods A total of 114 patients,whose hemorrhage etiology could not be determined by conventional gastroscopy,enteroscopy and gastroenterography,underwent DBE.With pathological results as diagnostic criteria,the value of double-balloon enteroscopy for obscure gastrointestinal bleeding diagnosis was studied.Results The sensitivity,specificity and accuracy of DBE for OGIB were 85.86％,63.63％,81.57％,respectively.The positive likelihood ratio was 2.36 and the negative likelihood ratio was 0.22.The total days of hospitalization,hospital costs,cost of hospital drugs were lower in the DBE group than in the control group(27.2 ± 11.8 days VS 16.4 ±5.3 days,35 690.2 ±3 466.5 Yuan VS 19 409.3 ± 9 253.2 Yuan,17 805.8 ± 2 145.5 Yuan VS 9 133.0 ± 4 664.9 Yuan) (all P ＜ 0.05).Conclusion DBE plays an important role in diagnosis of OGIB.It has significance in clinic,health economics,and social benefits.