北京单中心回顾性分析儿童肠镜临床特点及疾病谱12年演变

doi:10.19723/j.issn.1671-167X.2019.05.005

摘要/Abstract

摘要：

目的:回顾性分析北京大学第三医院12年来进行的儿童肠镜检查资料,探讨北京地区儿童肠道疾病谱及演变情况。方法:病例检索2005年1月1日至2017年7月20日北京大学第三医院不满18岁的接受肠镜检查患者资料并进行回顾性分析。根据患者年龄将其分为0~3岁组,4~6岁组,7~14岁组和15~17岁组,另根据检查时间分为2005—2011年组和2012—2017年组。结果:符合本研究入选标准的共326例患者,其中0~3岁组31例(9.5%),4~6岁组28例(8.6%),7~14岁组96例(29.4%),15~17岁组171例(52.5%)。90.5%(295/326)的患者肠镜能够到达回肠末段,没有穿孔等严重并发症,92.3%(301/326)的患者肠道清洁满意。204例(62.6%)患者肠镜下有阳性发现,非特异性回肠结肠炎最多见(27.0%),其次是炎症性肠病(14.1%)和息肉(12.0%)。比较2005—2011年组和2012—2017年组数据,后者接受检查的婴幼儿(0~3岁组)明显增多(3.0% vs. 14.1%,P=0.001), 肠镜到达回肠末段者明显增多(85.9% vs. 93.7%, P=0.037),但是疾病谱没有明显变化(P=0.850)。结论:儿童进行结肠镜检查安全有效,结肠炎和末段回肠炎性病变是最常见的诊断,炎症性肠病(inflammatory bowel disease,IBD)位于第2位。近12年来儿童结肠镜下发现疾病谱并没有发生显著变化,IBD的发现率没有像中国南方各省一样快速增加。

关键词: 儿童, 肠镜, 诊断, 胃肠疾病

Abstract:

Objective: To investigate the demographics and diagnostic yield in a cohort of Chinese pediatric patients undergoing colonoscopy in one institution over 12 years. Methouds: The study participants were consecutive patients aged <18 years that underwent their first colonoscopy in the endoscopy center at Peking University Third Hospital between Jan. 1, 2005 and Dec. 31, 2017. Demographic, endoscopic, and pathological findings were collected. According to the age of the patients, they were divided into 0-3 year-old group, 4-6 year-old group, 7-14 year-old group and 15-17 year-old group. The patients were also divided into 2005-2011 group and 2012-2017 group, according to the time of colonoscopy. Results: The cohort consisted of 326 patients, including 205 boys (62.9%) and 121 girls (37.1%). In the study, 31 patients (9.5%) were in 0-3 year-old group, 28 (8.6%) were in 4-6 year-old group, 96 (29.4%) were in 7-14 year-old group and 171 (52.5%) in 15-17 year-old group. The terminal ileum intubation success rate was 90.5% (295/326). No serious complications such as hemorrhage or perforation occurred during the procedures. The cleaning effect was good in 92.3% (301/326) of the patients. A total of 204 patients (62.6%) received a positive diagnosis under colonoscopy. 27.0% (88/326) of the patients was diagnosed as nonspecific colitis or terminal ileitis. 46 (14.1%) with inflammatory bowel disease (IBD) and 39 (12.0%) with polyp. The diseases were significantly different among the different age groups. The highest IBD diagnostic rate was found in 0-3 year-old group (7/31, 22.5%), while the highest polyp finding rate was in 4-6 year-old group (8/28, 28.6%). The number of the patients in 0-3 year-old group was significantly increasing in 2012-2017 group compared with 2005-2011 group (27/191 vs. 4/135, P=0.001), while the terminal ileum intubation success rate was higher (179/191 vs. 116/135, P=0.037). However, comparisons between years 2005-2011 and 2012-2017 showed that neither IBD nor polyp detection rate changed significantly (P=0.850). Conclusion: Colonoscopy in pediatric patients was a safe and effective procedure. Colitis or terminal ileitis was the primary finding during colonoscopy while IBD was the second one, and polyp was the third. However, the diagnostic yield did not change significantly. IBD was not as quickly increased in our hospital as it was in South China.

Key words: Child, Colonoscopy, Diagnosis, Gastrointestinal diseases

中图分类号:

R574

李军,顾芳,李在玲,吕愈敏. 北京单中心回顾性分析儿童肠镜临床特点及疾病谱12年演变[J]. 北京大学学报（医学版）, 2019, 51(5): 819-823.

Jun LI,Fang GU,Zai-ling LI,Yu-min LU. Pediatric colonoscopy findings and changing patterns from Beijing in one institutional experience over 12 years[J]. Journal of Peking University(Health Sciences), 2019, 51(5): 819-823.

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参考文献 13

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Items	Total	0-3	4-6	7-14	15-18	P
Cases	326	31 (9.5)	28 (8.6)	96 (29.4)	171 (52.5)	-
Numbers	385	36 (9.4)	32 (8.3)	112 (29.1)	205 (53.2)	-
Gender						0.905
Male	205	20 (64.5)	17 (60.7)	63 (65.6)	105 (61.4)
Female	121	11 (35.5)	11 (39.3)	33 (34.4)	66 (38.6)
Depth (the 1st colonoscopy, n=440)						0.368
Terminal ileum	295	30 (96.8)	26 (92.9)	85 (88.5)	154 (90.0)
Cecum	14	0	0	6 (6.3)	8 (4.7)
Colon	17	1 (3.2)	2 (7.1)	5 (5.2)	9 (5.3)
Cleaning effect						0.187
Good	222	26 (83.9)	21 (75.0)	64 (66.7)	111 (64.9)
Fair	79	4 (12.9)	4 (14.3)	22 (22.9)	49 (28.7)
Poor	25	1 (3.2)	3 (10.7)	10 (10.4)	11 (6.4)

Items	Total (n=326)	0-3 (n=31)	4-6 (n=28)	7-14 (n=96)	15-18 (n=171)	P
Negative	122 (37.4)	5 (16.1)	6 (21.4)	31 (32.3)	80 (46.8)	0.001
Nonspecific colitis or terminal ileitis	88 (27.0)	11 (35.5)	6 (21.4)	34 (35.4)	37 (21.6)	0.060
IBD	46 (14.1)	7 (22.5)	3 (10.7)	14 (14.6)	22 (12.9)	0.546
UC	11	0	0	6 (6.3)	5 (2.9)
CD	12	2 (6.4)	1 (3.6)	0	9 (5.3)
un-determined	23	5 (16.1)	2 (7.1)	8 (8.3)	8 (4.6)
TB	5 (1.5)	0	0	2 (2.1)	3 (1.8)	-
Polyp	39 (12.0)	6 (19.4)	8 (28.6)	10 (10.4)	15 (8.8)	0.030
FAP	8	1 (3.2)	0	3 (3.1)	4 (2.3)
Juvenile polyp	6	1 (3.2)	0	3 (3.1)	2 (1.2)
Allergic purpura	10 (3.1)	0	3 (10.7)	1 (1.0)	6 (3.5)	-
Vascular malformation	4 (1.2)	1 (3.2)	1 (3.6)	1 (1.0)	1 (0.6)	-
Diverticulum	2 (0.6)	0	0	1 (1.0)	1 (0.6)	-
Others	10 (3.1)	1 (3.2)	1 (3.6)	2 (2.1)	6 (3.5)	-

Items	2005-2011	2012-2017	P
Cases	135	191
Average age/years	13.6±4.0	11.7±5.6	0.001
Age, n(%)			0.001
0-3	4 (3.0)	27 (14.1)
4-6	8 (5.9)	20 (10.5)
7-14	45 (33.3)	51 (26.7)
15-17	78 (57.8)	93 (48.7)
Gender, n(%)			0.235
Male	90 (66.7)	115 (60.2)
Female	45 (33.3)	76 (39.8)
Depth (the 1st colonoscopy), n(%)			0.037
Terminal ileum	116 (85.9)	179 (93.7)
Cecum	10 (7.4)	4 (2.1)
Colon	9 (6.7)	8 (4.2)
Cleaning effect, n(%)			0.335
Good	96 (71.1)	126 (66.0)
Fair	32 (23.7)	47 (24.6)
Poor	7 (5.2)	18 (9.4)

Items	2005-2011 (n=135)	2012-2017 (n=191)
Negative	49 (36.3)	73 (38.2)
Nonspecific colitis or terminal ileitis	39 (28.9)	49 (25.7)
IBD	23 (17.0)	23 (12.0)
UC	5 (3.7)	6 (3.1)
CD	8 (5.9)	4 (2.1)
TB	2 (1.5)	3 (1.6)
Polyp	14 (10.4)	25 (13.1)
FAP	3 (2.2)	5 (2.6)
Juvenile polyp	2 (1.5)	4 (2.1)
Allergic purpura	4 (3.0)	6 (3.1)
Vascular malformation	1 (0.7)	3 (1.6)
Diverticulum	1 (0.7)	1 (0.5)
Others	2 (1.5)	8 (4.2)