西甲硅油乳剂在结肠镜检查中的应用与研究

目的 研究西甲硅油乳剂在结肠镜检查术前肠道准备中的应用价值.方法 将200例接受结肠镜检查的患者随机分为两组,实验组100例,对照组100例.实验组给予聚乙二醇电解质散+西甲硅油乳剂,对照组给予口服聚乙二醇电解质散.观察二组的效果.结果 实验组肠腔内气泡存在量明显少于对照组,术后腹胀程度明显轻于对照组,内镜医师操作满意度优于对照组(P＜0.05),而两组肠道清洁程度无差异(P＞0.05).结论 在结肠镜检查术前肠道准备中应用西甲硅油乳剂能够消除泡沫,提高视野清晰度,减少术后腹胀等不良反应,提高术者操作舒适度,缩短操作时间.     

The impact of patient education on the quality of inpatient bowel preparation for colonoscopy

BACKGROUND:

For patients requiring colonoscopy while admitted to hospital, achieving adequate cleansing of the colon is often difficult.

OBJECTIVES:

To assess the impact of patient education, in the form of both counselling and written instructions, on bowel cleanliness at colonoscopy.

METHODS:

A total of 38 inpatients at a tertiary care hospital in Vancouver, British Columbia, who were referred to the gastroenterology service for colonoscopy were enrolled in the present study. Sixteen patients were randomly assigned to the intervention group, while 22 patients comprised the control group. Both groups received a clear liquid diet and 4 L of a commercially available bowel preparation. The intervention group also received a brief counselling session and written instructions outlining the methods and rationale for bowel preparation before colonoscopy. Bowel cleanliness was assessed by the endoscopist using a five-point rating scale.

RESULTS:

The two groups were similar with respect to demographics, the indication for colonoscopy and findings at colonoscopy. The median bowel cleanliness scores in the control group and the enhanced-instruction group were 3.0 and 2.0, respectively (P=0.001).

CONCLUSION:

Patient counselling and written instructions are inexpensive, safe and simple interventions. Such interventions are an effective means of optimizing colonoscopy preparation in the inpatient setting.     

Factors associated with colonoscopy performed in nonhospital settings

BACKGROUND:

Colonoscopy is being increasingly performed in facilities outside of hospitals. Regulation of these facilities is variable, and concerns regarding the quality of procedures in nonhospital (NH) settings have been raised. Further study is needed to better understand endoscopic practice in these facilities.

OBJECTIVES:

To describe NH-based colonoscopy practice in Ontario from 1993 to 2005, and to identify patient (age, sex, income quintile and comorbidity) and physician (specialty and colonoscopy volume) factors associated with this practice.

METHODS:

The present study was a population-based, cross-sectional analysis using health administrative data from Ontario adults who underwent at least one outpatient colonoscopy between 1993 and 2005. A total of 1,240,781 patients underwent 1,917,714 colonoscopies. The main outcome measure was the receipt of colonoscopy in an NH facility.

RESULTS:

An increase in NH-based colonoscopy from 10.0% in 1993 to 15.1% in 2005 (P<0.0001) was found. In the multivariate model, younger, healthier men living in higher income areas were significantly more likely to undergo NH-based colonoscopy. Surgeons and other practitioners (eg, nongastroenterologists and noninternists) were significantly more likely to practice in NH settings. Physicians in the highest colonoscopy volume quintile were 25 times more likely to practice in NH settings than those in the lowest volume quintile (P<0.0001).

CONCLUSION:

Rates of NH-based colonoscopy are rising in Ontario. High-volume endoscopists and surgeons are most likely to practice in NH settings. Given its increasing use, further study of the practice and the regulation of NH colonoscopy is warranted.     

Effect of hysterectomy on colonoscopy completion rate

BACKGROUND:

Several studies show that colonoscopies are technically more difficult to perform in women than men, especially in women who have undergone abdominal and gynecological surgeries. A review of the literature indicates an increased rate of noncompletion of colonoscopies in most cases; however, no studies have investigated the procedural complication rate, sedation requirements and perception of pain in colonoscopies.

OBJECTIVE:

To determine whether women who have undergone a previous hysterectomy have a higher noncompletion rate when undergoing a colonoscopy, and to assess whether there is a higher percentage of complications. Furthermore, the present study also aimed to ascertain whether these women required more sedation and whether their perception of pain is greater than that of women who did not undergo previous abdominal surgeries.

METHODS:

The present study was a prospective cohort study of women, 45 to 80 years of age, who underwent colonoscopy (n=508). A total of 229 patients were eligible for the study; they completed a questionnaire, and were subsequently divided into control and hysterectomy groups. Gastroenterologists performed all procedures. After colonoscopy, the patient and endoscopist completed a pain perception questionnaire. Cecal intubation rates were also recorded.

RESULTS:

No significant difference for cecal intubation rates were detected between the two groups (95.7% and 98.7% in hysterectomy and control groups, respectively; P=0.176). The crude OR for the success rate was 0.29 (95% CI 0.05 to 1.90). There was no significant difference between groups regarding sedation or the type of colonoscope. No correlation between the gastroenterologists’ evaluation of pain and patients’ pain was observed.

CONCLUSION:

Hysterectomy did not significantly diminish the cecal intubation rate, and there was no detectable difference in pain perception or sedative dose. Colonoscopy remains an excellent screening and diagnostic tool for all women.     

Comparing patient and endoscopist perceptions of the colonoscopy indication

BACKGROUND

Determining whether a colonoscopy is performed for screening or nonscreening purposes can facilitate clinical practice and research. However, there is no simple method to determine the colonoscopy indication using patient medical files or health administrative databases.

OBJECTIVE

To determine patient-endoscopist agreement on the colonoscopy indication.

METHODS

A cross-sectional study was conducted among staff endoscopists and their patients at seven university-affiliated hospitals in Montreal, Quebec. The study participants were 50 to 75 years of age, they were able to understand English or French, and were about to undergo colonoscopy. Self- (endoscopist) and interviewer-administered (patient) questionnaires ascertained information that permitted classification of the colonoscopy indication. Patient colonoscopy indication was defined as the following: perceived screening (routine screening, family history, age); perceived nonscreening (follow-up); medical history that implied nonscreening; and a combination of the three preceding indications. Agreement between patient and endoscopist indications was measured using concordance and Kappa statistic.

RESULTS

In total, 702 patients and 38 endoscopists participated. The three most common reasons for undergoing colonoscopy were routine screening/regular check-up (33.8%), follow-up to a previous problem (30.2%) and other problem (24.6%). Concordance (range 0.79 to 0.85) and Kappa (range 0.58 to 0.70) were highest for perceived nonscreening colonoscopy. Recent large bowel symptoms accounted for 120 occurrences of disagreement in which the patient perceived a nonscreening colonoscopy while the endoscopist perceived a screening colonoscopy.

CONCLUSIONS

Patient self-report may be an acceptable means for rapidly assessing whether a colonoscopy is performed for screening or nonscreening purposes. Delivery of patient-centred care may help patients and endoscopists reach a shared understanding of the reason for colonoscopy.     

电子肠镜定位下腹腔镜辅助结肠息肉切除10例临床分析

目的：探讨电子肠镜定位下施行腹腔镜辅助结肠息肉切除的手术方法及注意事项。方法：回顾分析10例电子肠镜定位下施行腹腔镜辅助结肠息肉切除患者的临床资料,对手术方法及注意事项进行探讨。结果：本组10例患者均痊愈出院。平均手术时间为（75.00±19.58） min;平均术中出血为（37.00±9.49） ml;平均首次肛门排气时间为（38.40±15.02） h;平均住院时间为（8.20±0.79） d。随访6～12个月未见复发。定位点与息肉基底部所在的肠管横断面距离最短0 cm,最长6 cm。镜下仅1例隐约有息肉影,其余9例均看不到息肉影。定位点有6例偏向息肉近侧,2例偏向远侧,2例在准确位置上。结论：电子肠镜定位腹腔镜辅助结肠息肉切除是安全可行的方法;但一般不能看到明确的息肉影,仅靠光感定位及器械触碰与肠镜观察配合定位,术中适当调整肠镜光强度和镜头角度并注意双镜配合,可获较准确的定位效果。     

磷酸钠盐口服溶液在结肠镜检查前肠道准备中的应用

目的 观察磷酸钠盐口服溶液清洁肠管的效果和不良反应.方法 应用磷酸钠盐口服溶液进行结肠镜检查前肠道准备,136例患者随机分为对照组和观察组,对照组口服聚乙二醇电解质散,观察组口服磷酸钠盐口服溶液.观察用药过程中排便情况,肠腔清洗效果和气泡存在情况,比较服药前后3 d便性状及次数,记录不良反应.结果 131例患者完成观察...     

肠镜诊断结直肠癌的临床病理分析

目的:探讨肠镜活检诊断结直肠癌的临床病理学特征.方法:回顾性分析98例经术后病理证实的结直肠癌患者肠镜活检的临床资料,并总结分析其临床病理特征.结果:98例患者性别无显著差异(P＞0.05);≥55岁者(66例)显著多于＜55岁者(32例)(P＜0.01);病理类型以腺癌为主(83.7％),其中中分化腺癌占76.5％ (75/98),低分化腺癌4.1％(4/98),黏液腺癌3.1％(3/98),未分化癌、印戒细胞癌及腺鳞癌、鳞癌等其它病理类型则较为少见;发病部位以直肠最为多见(70.5％),其次为左半结肠(26.5％).结论:结直肠癌好发于年龄≥55岁老年人,且以直肠、左半结肠最为常见,而病理类型则以腺癌尤其是分化较高的腺癌最为常见,对于有不同程度大便习惯改变或黏液便、血便或大便性状改变等表现的老年患者进行肠镜检查,对该病的早期诊断具有重要意义.     

丙泊酚和咪唑安定复合哌替啶在门诊结肠镜检查中的比较研究

目的比较丙泊酚和咪唑安定复合哌替啶在门诊无痛结肠镜检查中的临床效果和安全性。方法将80例拟行无痛结肠镜检查患者随机分为P组（丙泊酚1.5 mg/kg）和MM两组（咪唑安定0.05 mg/kg＋哌替啶1.5 mg/kg）,观察患者给药前、插镜时、睁眼时的血压、心率、血氧饱和度,记录麻醉期间的不良反应例数、肠镜检查时间、清醒时间以及VAS疼痛评分。结果两组患者麻醉过程中各时相点血压、心率、血氧饱和度差异均无统计学意义（P〉0.05）;P组肠镜检查时间和清醒时间均短于MM组,差异有统计学意义（P〈0.05）;P组VAS评分低于MM组,差异有统计学意义（P〈0.05）。结论丙泊酚和咪唑安定复合哌替啶均可很好地完成门诊无痛结肠镜检查,而丙泊酚相对来说更具优点,值得推广。     

咪哒唑仑联合氧化亚氮吸入麻醉在结肠镜检查中的应用

目的 探讨咪哒唑仑联合氧化亚氮吸入麻醉在结肠镜检查中的可行性和安全性.方法 108例均应用咪哒唑仑与氧化亚氮吸入麻醉行结肠镜检查,观察并记录给药前、给药后、检查第3分钟及退镜后心率(HR)、收缩压(SBP)、舒张压(DBP)和脉搏血氧饱和度(SpO2)的变化.结果 给药后、检查第3分钟及退镜后各项观察指标与给药前比较差异无统计学意义(P>0.05);Ramsay镇静评分2级以上占94.4%.提示镇静和镇痛效果好.结论 咪哒唑仑联合氧化亚氮吸入麻醉用于结肠镜检查过程中各项生命体征平稳,安全有效.