International Journal of Clinical Research
International Journal of Clinical Research. 2024; 8: (3) ; 10.12208/j.ijcr.20240089 .
总浏览量: 146
1 杭州医学院临床医学院21级临床 浙江杭州
2 杭州医学院影像学院19级影像 浙江杭州
3 贵州省盘江投资控股（集团）有限公司总医院消化内科 贵州盘州
4 杭州医学院创新创业学院 浙江杭州
*通讯作者： 罗华,单位： 贵州省盘江投资控股（集团）有限公司总医院消化内科 贵州盘州；王黎芳,单位： 杭州医学院创新创业学院 浙江杭州；
目的 探讨以结肠镜单人操作为基础的透明帽辅助下全结肠注水交换法在临床的应用价值。方法 收集2014年9月3日至2019年9月3日在盘江总医院就诊的门诊病人及住院进行结肠镜检查的患者12573例的数据。所有患者完全无镇静镇痛的清醒状态。以透明帽辅助注水交换单人结肠镜操作的患者为试验组，以普通结肠镜单人操作注气组为对照组。比较两组成功插管至回肠末段的例数、时间、镜身长度、患者疼痛评分、并发症的发生情况。结果 透明帽辅助全结直肠注水交换组99.81%（7900/7915）成功插管进镜至回肠末段、仅0.019%（15/7915）未到达回盲部，普通结肠镜单人操作注气组90.00%（4192/4658）成功插管进镜至回肠末段、10.00%（466/4658）未到达回盲部。两组相比，透明帽辅助全结直肠注水交换组进镜到达回肠末端时间更短，到达回肠末端镜身长度更短、患者疼痛评分更低，回肠末段插管成功率更高，内镜诊疗并发症更低，且差异具有统计学意义（P＜0.05）。两组均无严重并发症发生。结论 透明帽辅助注水交换单人结肠镜广泛适用于难以实施常规结肠镜且存在较多结肠镜检查并发症风险的患者。在无镇静镇痛完全清醒状态下，可以安全高效地实施结直肠至回肠末段检查及介入治疗。本技术在结直肠早癌筛查、结直肠疾病的精细诊断和内镜介入治疗具有广泛推广的临床应用价值。
Objective To explore the clinical application value of the transparent cap-assisted total colonic water exchange method based on colonoscopy single operation. Methods Data were collected on 12,573 outpatients and hospitalized patients undergoing colonoscopy at Panjiang General Hospital from September 3, 2014 to September 3, 2019. All patients were completely awake without sedation and analgesia. The patients with transparent cap assisted water injection exchange single colonoscopy operation were the experimental group, and the ordinary colonoscopy single operation gas injection group was the control group. The number of cases, time, lens length, pain score, and complications of successful intubation to the end ileum between the two groups were compared. Results 99.81% (7900/7915) of the transparent cap assisted by the total colorectal water exchange group were successfully intubated to the terminal ileal segment, only 0.019% (15/7915) did not reach the ileocecal part, 90.00% (4192/4658) of the ordinary colonoscopy single operation gas injection group were successfully intubated to the terminal ileum, and 10.00% (466/4658) did not reach the ileocecal part. Compared with the two groups, the transparent cap-assisted total colorectal water exchange group had a shorter time to reach the end ileum, a shorter length of the lens body to reach the end of the ileum, a lower pain score, a higher success rate of terminal ileal intubation, and lower complications in endoscopic diagnosis and treatment, and the difference was statistically significant (P<0.05). There were no serious complications in either group. Conclusion Clear cap-assisted water exchange single colonoscopy is widely used in patients who are difficult to perform conventional colonoscopy and are at risk of colonoscopy complications. In the fully awake state without sedation and analgesia, colorectal to terminal ileal examination and interventional therapy can be performed safely and efficiently. This technology has widely promoted clinical application value in early colorectal cancer screening, fine diagnosis of colorectal diseases and endoscopic interventional treatment.
[1] 田伟,田震,王一祺,等. 低容量聚乙二醇电解质散联合首荟通便胶囊在慢性功能性便秘患者结肠镜检查肠道准备中的应用研究[J]. 中国内镜杂志,2023,29(1):62-70.
[2] 王梦,连聪珍. 不同时间分次服用低容量聚乙二醇电解质散对儿童无痛结肠镜检查前肠道准备的临床研究 [J]. 中国肛肠病杂志,2023,43(2):78-80.
[3] VERGIS N,GRATH A K,STODDART C H,et al．Right or left in colonoscopy(ROLCOL)? A Randomized Controlled Trial of Right- versus Left-Sided Starting Position in Colonoscopy [J]. Am J Gas- troenterol,2015,110(1):1576-1581.
[4] 翟春颖,柯小丽,徐耀华等. 注气和注水结肠镜下结直肠息肉的内镜形态特征与病理类型的关系分析 [J]. 中国医学创新2023,20(2):64-68.
[5] 王炘. 改良注水法在老年患者清醒结肠镜检查中的应用 [J].临床消化病杂志,2020,32(5):309-311.
[6] Portocarrero DJ CK OS. A pilot study to assess feasibility of the water method to aid colonscope insertion in community setting in the United States [J]. J Interv Gastroenterol, 2012,2(1):20-22.
[7] 赖雪莹,汤小伟,黄思霖,等. 结肠镜检查过程中疼痛的危险因素分析 [J]．南方医科大学学报,2017,37(4):482-487.
[8] Leung FW. Water-related techniques for performance of colonoscopy. Dig Dis Sci. 2008 Nov;53(11):2847-50.
[9] Cadoni S, Falt P, Gallittu P, et al. Water Exchange Is the Least Painful Colonoscope Insertion Technique and Increases Completion of Unsedated Colonoscopy [J].Clin Gastroenterol Hepantol, 2015,13(11): 1972-1980.
[10] PUIG I,LOPEZ-CERON M,ARNAU A,et al. Accuracy of the Narrow-band Imaging International Colorectal Endoscopic Classification System in Identification of Deep Invasion in Colorectal Polyps[J]. Gastroenterology, 2019, 156(1):75-87.
[11] Koulaouzidis Anastasios; Dabos Konstantinos; Toth Ervin, et al. Diving method or simply…water-immersion small-bowel capsule endoscopy[J]. Gastrointestinal Endoscopy, 2021,94(4):878-879.
[12] 蔡升,张芳芳,黄戬等. 透明帽辅助水交换结肠镜联合窄带成像内镜检查的临床应用价值 [J]. 中国内镜杂志, 2021, 27(10):18-23.
[13] Leung FW.Water-related techniques for performance of Colonoscopy [J]. Dig Dis Sci ,2008,5(11):2847-2850.
[14] Shaukat A, Kahi CJ, Burke CA,et al. ACG Clinical Guidelines: Colorectal Cancer Screening 2021 [J]. Am J Gastroenterol 2021; 116: 458-479.
[15] Cadoni S, Sanna S, Gallittu P,et al.A randomized, controlled trial comparing real-time insertion pain during colonoscopy confirmed water exchange to be superior to water immersion in enhancing patient comfort [J]. Gastrointest Endosc,2015.81(3):557-566.
[16] 中华人民共和国卫生和计划生育委员会医政医管局,中华医学会肿瘤学分会. 中国结直肠癌诊疗规范（2017年版）[J]. 中国实用外科杂志,2018,56(4):241-258.
[17] Falt P,S(v)majstrla, Fojtik,et al. Cool water vs warm water immersion for minimal sedation colonoscopy: a double-blind randomized trial [J]. Colorectal Dis,2013,15(10): 612 -617.
[18] 杜丽,魏子白,张俊峰,等. 温水灌注插镜法对难做性结肠镜检查效果分析[J]. 长治医学院报,2014,5:387-380.11. 011.