胶囊内镜诊断新进重庆2014

胶囊内镜诊断新进展（重庆）,第三军医大学新桥医院消化内科赵晓晏 杨歆2014-5-24,内镜发展史,Kussmaul(德国),Hirschowitz(美国),CCD,NOTES治疗内镜色素内镜细胞内镜,胶囊内镜发展史,在胶囊内镜正式问世之前，经历了近30年的酝酿、构思和研发过程,1981,1998,2001,2004,首次有人萌发研制无线内窥镜的设想,世界上出现第一个实验用胶囊内镜雏形,全球首家胶囊内镜问世,中国第一个胶囊内镜在重庆诞生,目前,日本、韩国也已问世,有效性,食管病变,肠道恶性淋巴瘤,肠道海绵状血管瘤,小肠腺癌,卵巢癌侵犯盲肠,OMOM胶囊内镜临床应用初步评价,SCI文献,Indications of capsule endoscopy in the final included original articles,Detection rate, complete examination, and retention rate of capsule endoscopyin patients with different indications,Detailed clinically significant findings by capsule endoscopy in the patients with obscure GI bleeding,胶囊内镜对小肠疾病诊断有价值,Results for complete visualization of the stomach,Complete visualization, 61 patients,Jean-Francois Rey Gastrointestinal Endoscopy Volume 75, Issue 2, Pages 373381,Results for complete visualization of the stomach,Complete visualization, 61 patients,胶囊内镜机器人姿态控制系统,Before,After,Timer plug,乳果糖/钡剂,RFID tag,Uncoated exposed window for fluid erosion,聚对二甲苯包衣,Patency Capsule,Spada C. et.al. A novel diagnositc tool for detecting functional patency of the small bowel: the Given patency capsule. Endoscopy 2005;37;9:793-800,40小时后，试验囊崩解在40小时内，约80%的患者会完整的排出胶囊,试验流程,Spada C. et.al. A novel diagnositc tool for detecting functional patency of the small bowel: the Given patency capsule. Endoscopy 2005;37;9:793-800,Suture marker lesion detection rates of a colonoscope, unmodified MiroCam capsule endoscope,and SCE,OMOM pH食道无线监测系统,胶囊内镜检查并发症,胶囊滞留1-5%肠梗阻0.5%胶囊穿透罕见胶囊误吸罕见,Factors/lesions responsible for or associated with capsule retention,Gastrointestinal Endoscopy Volume 71, 2010,胶囊内镜的滞留,滞留的定义：胶囊内镜在消化道内停留的时间超过2周，需要药物，小肠镜或者手术解除滞留约58.7%的胶囊内镜滞留患者需要外科手术,What is already known on this topic Video retention in the small bowel may occur in 1.4% to 13% of cases. What this study adds to our knowledge In a retrospective study of 904 studies, 8 patients retained the video were successfully removed by using double-balloon,胶囊嵌顿并穿透,在严重脊柱侧弯的患者中，胶囊内镜卡在了支气管中,发生胶囊内镜误吸的风险,急性卒中/脑血管疾病史神经系统疾病 重症肌无力 帕金森氏症 唐氏综合症 继发于糖尿病的神经病变高龄头颈部疾病、手术或治疗史心肌梗死慢性阻塞性肺疾病长期气管插管史。,如果胶囊内镜滞留我们怎么办？,合理的、措词适当的沟通是必要的!,胶囊滞留部位 = 病变部位，进一步检查,无症状胶囊滞留者经内科治疗后自然排出,出现梗阻、穿孔要及时处理,两镜争议,“胶囊优先”。对儿童和高龄老年人的检查尚未发生任何严重问题。双侧录像摄像机的应用(具有绝佳的光学控制功能),胶囊内镜将会获得空前的可视化效果。结肠检查的胶囊内镜已经开发出来,但目前未获得FDA的批准。微型手术刀的胶囊内镜。胶囊内镜的缺陷包括小肠检查不够全面,其发生率约15%大概仅有1%的需回收的胶囊滞留率。,两镜争议,对于高度怀疑有小肠疾病的患者,可应用双气囊小肠镜在消化道中部出血以及存在小肠狭窄的情况下,双气囊小肠镜是一个可靠且有效的方法,使用双气囊小肠镜可以准确定位正在出血的病灶,从而成功止血。另外,双气囊小肠镜还能到达胶囊内镜无法到达