术中按需喷洒与术前口服二甲硅油 在肠镜检查中的作用研究

〔摘 要〕 目的：探讨术中按需喷洒与术前口服二甲硅油在肠镜检查中的应用效果。 方法：选取 2020 年 1 月至 2021 年 6 月于萍乡市人民医院行肠镜检查的无明显症状患者 90 例，按随机数字表法分为两组，对照组和观察组各 45 例。两组均 使用聚乙二醇电解质散清洁肠道，对照组术前口服二甲硅油，观察组术中按需喷洒二甲硅油。比较两组患者肠道清洁分级、 气泡分级、二甲硅油用量、肠镜检查操作时间、结肠息肉检出率及患者满意度。 结果： 两组患者肠道清洁分级相比，差异无 统计学意义（P ＞ 0.05）。观察组患者气泡分级 1 级率为 80.00 %，高于对照组的 62.22 %，差异具有统计学意义（P ＜ 0.05）。 观察组患者二甲硅油用量为（14.58 ± 2.01）mL，少于对照组的（22.35 ± 2.65）mL，进、退镜时间分别为（8.89 ± 1.14）min、 （8.33 ± 1.08）min，短于对照组的（9.76 ± 1.27）min、（10.27 ± 2.04）min，差异有统计学意义（P ＜ 0.05）。观察组患者 结肠息肉检出率、患者满意度为 17.78 %、97.78 %，高于对照组的 4.44 %、82.22 %，差异具有统计学意义（P ＜ 0.05）。 结论：术中按需喷洒二甲硅油在肠镜检查中效果更佳，可减少二甲硅油用量，提高视野清晰度，缩短肠镜检查操作时间， 并利于结肠息肉的检出，提高患者满意度。     

Moderate versus deep sedation in adults undergoing colonoscopy: systematic review and meta-analysis

Objective: To perform a systematic review and meta-analysis comparing effectiveness and safety of moderate and deep sedation during colonoscopy.

Research design and methods: We searched Medline, Embase, Central and Google scholar in May 2017 and updated in March 2018 to identify all randomized controlled trials that compared the effectiveness and safety of moderate and deep sedation during colonoscopy. The quality of studies was assessed using the “Risk of bias” tool. The primary endpoints were defined as patient satisfaction, physician satisfaction, incidence of recall and incidence of desaturation. Recovery time was also evaluated. Review Manager and Comprehensive Meta-Analysis software were used for statistical analysis.

Results: A total of 919 patients from three studies were included in the final analysis. The combined analysis did not reveal any differences in patient satisfaction between moderate and deep sedation (RR?=?0.94; 95% CI: 0.86 to 1.04; P_chi²?=?0.06; I²?=?65%; number needed to treat to harm [NNTH]?=?15.6; 95% CI: NNTH 7.8 to ∞ to number needed to treat to benefit [NNTB]?=?3078.0), physician satisfaction (RR?=?0.35; 95% CI: 0.02 to 6.95; P_chi² < 0.001; I²?=?100%; NNTB?=?1.6; 95% CI: 1.5 to 1.8), incidence of recall (RR?=?5.82; 95% CI: 0.51 to 66.48; P_chi²?=?0.11; I²?=?60%; NNTH?=?11.0; 95% CI: 7.5 to 20.5) or recovery time (mean difference?=?-6.77; 95% CI: -16.21 to 2.67; P_chi² < 0.001; I²?=?99%). However, incidence of desaturation was higher in the deep group than in the moderate group (RR?=?0.18; 95% CI: 0.01 to 0.99; P_chi²?=?0.48; I²?=?0%; NNTB?=?56.7; 95% CI: 31.6 to 273.1).

Conclusions: Moderate sedation showed comparable safety and effectiveness to deep sedation with respect to patient satisfaction, physician satisfaction, incidence of recall and recovery time.     

Rising Proportion of Young Individuals With Rectal and Colon Cancer

Background

Recent trends have identified increasing number of young individuals with rectal and colon cancers. These individuals, who are younger than 50 years old, in most instances would not meet screening guidelines. We aimed to report the characteristics and trend of the rising proportion of young individuals being diagnosed with rectal and colon cancers at our institutions.

成都地区433例0～6岁学龄前儿童结肠镜检查病因学分析

【摘要】目的 分析成都地区0~6岁学龄前儿童接受结肠镜检查患者的临床特征、肠镜诊断,并进行结肠镜检查的安全性分析。方法 回顾性分析2018年1月～2020年8月在成都市妇女儿童中心医院接受结肠镜检查的0～6岁学龄前儿童433例临床资料,将其分为两组,其中0～3岁组227例,4～6岁组206例。比较两组便血、腹痛、便秘、腹泻、肛门/肠道包块等检查原因。比较两组在慢性结肠炎、过敏性结肠炎、息肉、血管异常疾病检出率。分析儿童结肠镜检查的安全性。结果 433例患儿共完成440例次结肠镜检查,382例次结肠镜插入到盲肠,完成全结肠检查,盲肠插镜率为868%。主要检查原因包括便血281例,不明原因腹泻114 例,腹痛13 例,肛门/肠道包块12 例,便秘5例,肠道术后3例,下消化道异物2例。两组在便血、腹痛、便秘、腹泻、肛门/肠道包块等检查原因方面比较差异有统计学意义（P＜005）。433例患儿共396例检出病变,其中慢性结肠炎158例,结直肠息肉127例,过敏性结肠炎62例,炎症性肠病5例,血管异常5例,其他过敏性紫癜、肠结核、痔疮、肛瘘、消化道异物等共39例。两组在慢性结肠炎、过敏性结肠炎、息肉、血管异常疾病检出比较差异有统计学意义（P＜005）。观察到不良事件45例,9例腹痛,22例术后发热,14例出血,多为一过性轻微不良反应,无穿孔发生。结论 儿童无痛结肠镜检查安全,对慢性腹泻、便血等疾病病因有重要诊断作用,学龄前儿童结肠镜下检出疾病有其特定疾病谱,0～3岁和4～6岁疾病分布也有差异。     

Less patient discomfort by one-man colonoscopy examination

A randomised prospective trial compared safety and patient tolerance for one-man method with two-man method undergoing colonoscopy. Eighty patients were randomized to 1 of 2 groups: the two-man method group (n = 40); or the one-man method group (n = 40). All colonoscopic examinations were performed by the same endoscopist to reduce skill-based variation. Patient tolerance for colonoscopy was evaluated with a numerical rating scale ranging from 0 for painless to 5 for maximal pain. Cardiopulmonary parameters were recorded during the procedure. Patients receiving one-man method had lower pain score than two-man method. The length of the scope reach to the cecum was shorter in the one-man group than the two-man group. The patients underwent two-man colonoscopy had higher maximum increase in heart rate during the procedure compared with one-man group. One-man colonoscopy can improve patient tolerance and reduces patient pain by decreasing the redundancy of colonoscope during the procedure.     

Colonoscopic Perforation Management by Laparoendoscopy: An Algorithm

Background and Objectives:

The role of laparoscopy in the management of iatrogenic colonoscopic injuries has increased with surgeons becoming facile with minimally invasive methods. However, with a limited number of reported cases of successful laparoscopic repair, the exact role of this modality is still being defined. Drawing from previous literature and our own experiences, we have formulated a simple algorithm that has helped us treat colonoscopic perforations.

Methods:

A retrospective review was undertaken of patients treated for colonoscopic perforations since the algorithm''s introduction. For each patient, initial clinical assessment, management, and postoperative recovery were carefully documented. A Medline search was performed, incorporating the following search words: colonoscopy, perforation, and laparoscopy. Twenty-three articles involving 106 patients were identified and reviewed.

Results:

Between May 2009 and August 2012, 7 consecutive patients with colonoscopic perforations were managed by 2 surgeons using the algorithm. There were no complications and no deaths, with a mean length of stay of 4.43 days (range, 2–7 days). Of the 7 patients, 6 required surgery. A single patient was managed conservatively and later underwent an elective colon resection.

Conclusions:

Traditionally, laparotomy was the preferred method for treating colonoscopic perforations. Our initial experience reinforces previous views that laparoendoscopic surgery is a safe and effective alternative to traditional surgery for managing this complication. We have formulated a simple algorithm that we have found helpful for surgeons considering a laparoscopic approach to managing this condition.     

Validity evidence for the Simulated Colonoscopy Objective Performance Evaluation scoring system

Background

Low-cost, objective systems to assess and train endoscopy skills are needed. The aim of this study was to evaluate the ability of Simulated Colonoscopy Objective Performance Evaluation to assess the skills required to perform endoscopy.

Methods

Thirty-eight subjects were included in this study, all of whom performed 4 tasks. The scoring system measured performance by calculating precision and efficiency. Data analysis assessed the relationship between colonoscopy experience and performance on each task and the overall score.

Results

Endoscopic trainees' Simulated Colonoscopy Objective Performance Evaluation scores correlated significantly with total colonoscopy experience (r = .61, P = .003) and experience in the past 12 months (r = .63, P = .002). Significant differences were seen among practicing endoscopists, nonendoscopic surgeons, and trainees (P < .0001). When the 4 tasks were analyzed, each showed significant correlation with colonoscopy experience (scope manipulation, r = .44, P = .044; tool targeting, r = .45, P = .04; loop management, r = .47, P = .032; mucosal inspection, r = .65, P = .001) and significant differences in performance between the endoscopist groups, except for mucosal inspection (scope manipulation, P < .0001; tool targeting, P = .002; loop management, P = .0008; mucosal inspection, P = .27).

Conclusions

Simulated Colonoscopy Objective Performance Evaluation objectively assesses the technical skills required to perform endoscopy and shows promise as a platform for proficiency-based skills training.     

Microperforation of the colon: animal model in rats to reproduce mucosal thermal damage

Background

The aim of the present study was to develop a rat model of colonic microperforation secondary to thermal injury for future studies to assess new treatments.

Methods

Twenty-four male Sprague–Dawley rats were used in this study. Hot biopsy forceps were used for all treatments. All lesions were created in proximal left colon using the soft coagulation setting. The power setting tested was 40 W, and the durations of monopolar soft coagulation application evaluated were 2, 3, and 4 s.

Results

In the acute phase, 48 h after thermal injury, durations of cautery of 2 and 3 s resulted in transmural necrosis, whereas with 4 s microperforation was obtained. In the late phase, 7 d after the damage, only duration of cautery of 4 s showed deep cautery effects, with signs of peritonitis.

Conclusions

We determined optimal power settings and duration of therapy in a rat model for producing electrocautery that involves transmural necrosis with microperforation.     

DOUBLE-BLIND PROSPECTIVE RANDOMIZED STUDY COMPARING POLYETHYLENE GLYCOL TO LACTULOSE FOR BOWEL PREPARATION IN COLONOSCOPY

Background

Colonoscopy is the most frequent exam used to evaluate colonic mucosa, allowing the diagnosis and treatment of many diseases. The appropriate bowel preparation is indispensable for the realization of colonoscopy. Therefore, it is necessary the use of laxative medications, preferentially by oral administration.

Aim

To compare two medications used in bowel preparation in adult patients going to ambulatory colonoscopy and to analyze the patients'' profile.

Methods

A double-blind prospective study with 200 patients, randomized in two groups: one that received polyethilene glycol and another that received lactulose. The patients answered to questionnaires to data compilation, as tolerance, symptoms and complications related to preparation. Besides, it was also evaluated the prepare efficacy related to the presence of fecal residue.

Results

Intestinal habit alterations and abdominal pain were the main reasons to realize the exams and hypertension was the most prevalent comorbidity. Ten percent of the ones who received lactulose didn''t get to finish the preparation and 50% considered the taste "bad, but tolerable". The most common subjective symptom after the medication was nausea, especially after lactulose. During the exam, most of the patients who used lactulose had a "light discomfort" and the ones who used polyethilene glycol considered the discomfort as "tolerable". The quality of the preparation was good in 75%, undependable of the medication that was used.

Conclusion

Polyethilene glycol was more tolerable when compared to lactulose, without difference on the quality of the preparation.     

利那洛肽联合复方聚乙二醇电解质散在门诊患者肠道准备中的临床应用

目的 探讨利那洛肽联合复方聚乙二醇电解质散（polyethylene glycol electrolytes powder,PEG）用于门诊患者肠镜检查前肠道准备的安全性及有效性。方法 选取2020年8月至2021年8月于台州市中心医院（台州学院附属医院）行肠镜检查的150例患者为研究对象,按照不同的肠道准备方法将其分为3L PEG组（50例）、4L PEG组（50例）和3L PEG+利那洛肽组（50例）。通过Boston肠道准备评分量表（Boston bowel preparation scale,BBPS）评价三组患者的肠道准备效果,并比较三组患者的不良反应及对肠道准备方案的满意度。结果 3L PEG组患者的左半结肠、横结肠、右半结肠评分及BBPS总评分均显著低于4L PEG组和3L PEG+利那洛肽组（P<0.05）;4L PEG组患者的左半结肠、横结肠、右半结肠评分及BBPS总评分与3L PEG+利那洛肽组比较,差异均无统计学意义（P>0.05）。3L PEG+利那洛肽组患者的首次排便时间明显短于3L PEG组和4L PEG组（F=18.860,P<0.001）。4L PEG组患者的满意度低于3L PEG组和3L PEG+利那洛肽组（P<0.05）,3L PEG+利那洛肽组患者的满意度最高。4L PEG组患者的不良反应发生率显著高于3L PEG组和3L PEG+利那洛肽组（P<0.05）。结论 肠镜检查前使用利那洛肽联合PEG进行肠道准备,可提高患者肠道准备质量,降低服药中的不良反应,缩短首次排便时间,提高患者的满意度,值得临床推广应用。