无痛肠镜检查误吸致ARDS死亡1例分析

无痛技术在临床诊疗中的应用日益广泛,误吸等严重并发症的防治亦需引起高度重视。本例说明,无痛肠镜检查中应注意气道保护以防范误吸的发生,而早期诊治则是误吸抢救的关键。     

结肠镜检前针刺合谷对镜检的影响

目的　研究结肠镜检前针刺双合谷对镜检患者及对插镜时间的影响。方法　依接受镜检单、双序号将全部结肠镜检患者 185例分为针刺组 (93例 )、对照组 (92例 )。针刺组在镜检前 30 min针刺双合谷 ,对照组不予任何防治措施。分别观察两组过乙状结肠和横结肠时的疼痛级别并记录插镜时间。结果　共有 16 5例患者完成插镜确定为有效病例 ,其中针刺组 84例 ,对照组 81例。统计表明 ,针刺组患者在过横结肠及乙状结肠时疼痛级别较对照组显著低 (P<0 .0 1) ,针刺组的插镜时间较对照组短 (P<0 .0 5 )。结论　结肠镜检前针刺双合谷可有效降低结肠镜检时患者的不适并缩短镜检时间。     

A preliminary prospective study of the usefulness of a magnetic endoscope locating device during colonoscopy

Background Although magnetic endoscope imaging of the colonoscope via the Endoscope Positioning Detecting Unit (EPDU) has been studied to some extent in Europe, its application in the United States has been limited. The purposes of this study were to determine whether the technique enabled for accurate localization of the lesion and to determine if and how the device facilitated scope insertion and completion of the colonoscopic exam.Methods Outpatient colonoscopies using the EPDU were performed by three experienced surgical endoscopists over a 5-month period. A specialized scope with electromagnetic coils or a regular scope with a magnetic probe insert in the instrument channel was used for the duration of the examination to identify loops and localize pathology.Results A total of 80 colonoscopies were performed with the device. In two patients, the probe insert was removed prior to completion of the procedure; thus, the total number of examinations included in the study was 78. The EPDU was used in conjunction with transillumination to estimate the location of polyps or cancers in the 33 patients (42%) in whom such lesions were found. In the four patients who subsequently underwent operation, the lesion’s location as estimated by EPDU was verified. In regard to the usefulness of the device during insertion, the EPDU led to the discovery of loops and to the application of pressure that resulted in prompt completion of the examination in 28% of cases (deemed most useful). In 33% of cases, the device identified loops and led to the application of abdominal wall pressure and early position changes, thus facilitating the examination; however it did not lead to its immediate or rapid completion. In 39% of cases, the device was not required or used for insertion due to the simple nature of the examination.Conclusions The EPDU was accurate in estimating lesion location. The device also holds promise as an aid in the completion of difficult exams (about 30% of cases in this study).     

Magnetic resonance colonography versus colonoscopy as a diagnostic investigation for colorectal cancer: a meta-analysis

AIMS: Magnetic resonance colonography (MRC) is emerging as a potential complementary investigation for the diagnosis of colorectal cancer (CRC) and also for benign pathology such as diverticular disease. A meta-analysis reporting the use of MRC is yet to be performed. The aim of this study was to evaluate the diagnostic accuracy of MRC compared with the gold-standard investigation, conventional colonoscopy (CC). METHODS: A literature search was carried out to identify studies containing comparative data between MRC findings and CC findings. Quantitative meta-analysis for diagnostic tests was performed, which included the calculation of independent sensitivities, specificities, diagnostic odds ratios, the construction of summary receiver operating characteristic (SROC) curves, pooled analysis and sensitivity analysis. The study heterogeneity was evaluated by the Q-test using a random-effect model to accommodate the cluster of outcomes between individual studies. RESULTS: In all, 8 comparative studies were identified, involving 563 patients. The calculated pooled sensitivity for all lesions was 75% (95% CI: 47% to 91%), the specificity was 96% (95% CI: 86% to 98%) and the area under the ROC curve was 90% (weighted). On sensitivity analysis, MRC had a better diagnostic accuracy for CRC than for polyps, with a sensitivity of 91% (95% CI: 97% to 91%), a specificity of 98% (95% CI: 66% to 99%) and an area under the ROC curve of 92%. There was no significant heterogeneity between the studies with regard to the diagnostic accuracy of MRC for CRC. CONCLUSION: This meta-analysis suggests that MRC is an imaging technique with high discrimination for cases presenting with colorectal cancer. The exact diagnostic role of MRC needs to be clarified (e.g. suitable for an elderly person with suspected CRC). Further evaluation is necessary to refine its applicability and diagnostic accuracy in comparison with other imaging methods such as computed tomography colonography.     

Antigranulocyte monoclonal antibody immunoscintigraphy in inflammatory bowel disease in children and young adolescents

Aim: Diagnostic delay for inflammatory bowel disease (IBD) is frequent, especially in paediatric patients. Scintigraphy with labelled leucocytes has been proposed as a very sensitive diagnostic tool for detecting bowel inflammation. The aim of this study was to evaluate the sensitivity and specificity of immunoscintigraphy in the diagnosis and follow-up of children with IBD and to compare this technique with other diagnostic techniques.

Methods: Sixty-six children with histologically confirmed IBD were enrolled in the study. Twenty-one children in whom IBD was suspected but subsequently not confirmed were used as controls. A total of 138 immunoscintigraphies were performed using 99m Technetium-labelled monoclonal anti-granulocyte antibodies. Immunoscintigraphy was also compared with other diagnostic techniques.

Results: Overall sensitivity of monoclonal antibody immunoscintigraphy (MoAb-IS) in patients with clinically active disease was 94% for Crohn's disease (CD) and 85% for ulcerative Ultrasonography, endoscopy and radiology were carried out at the same time in 29 patients with CD and in 6 patients with UC: sensitivity of IS was 90% compared with 76% of colonoscopy, 75% for enemas, and 55% for sonography. IS was negative (specificity) in 24% of patients with CD and in 67% of patients with UC during remission, and in 64% of controls with other causes of intestinal inflammation. Diagnostic delay was significantly shorter when compared with a historical cohort of patients.

Conclusion: Immunoscintigraphy is a highly sensitive detector of intestinal inflammation in young patients with IBD and can be useful for reducing diagnostic delay. However, its specificity is low and all positive cases must be confirmed histologically. colitis (UC).     

针刺镇痛结合咪达唑仑、瑞芬太尼在肠镜检查中的应用

目的研究针刺镇痛配伍使用咪达唑仑、瑞芬太尼在肠镜检查的镇痛、镇静效果。方法80例门诊肠镜检查患者随机分为2组,即针刺复合药物组(针刺镇痛配伍使用咪达唑仑、瑞芬太尼,Ⅰ组)和单纯药物组(咪达唑仑复合瑞芬太尼,Ⅱ组)。针刺取穴均为双侧合谷、右侧足三里、上巨虚,左侧阴陵泉、三阴交。连续监测患者血压、心率、氧饱和度(Sp0_2)变化;分别记录两组患者用药情况、插镜至回盲部时间、术中与术后不良反应以及检查后患者满意度。结果80例患者全部完成了肠镜检查,Ⅰ组患者瑞芬太尼用量及其最大效应室浓度均低于Ⅱ组(P<0.01);Ⅱ组患者术中MAP较给药前显著下降(P<0.05),同时术中HR亦低于Ⅰ组(P<0.05),两组患者SpO_2并无统计学差异。两组患者检查后满意度无明显不同。结论针刺镇痛配伍使用咪达唑仑、瑞芬太尼能有效地用于结肠镜检查的镇静镇痛,同时和单纯药物组相比可显著减少瑞芬太尼的用药量,术中及术后不良反应更少见,研究显示针刺能显著增强瑞芬太尼的镇痛作用。     

便血患者1 193例的常见病因及其与年龄的相关性

目的探讨便血患者的常见病因及其与年龄的相关性。方法分析我院2001年1月至2005年10月诊治的1193例便血患者的肠镜或双气囊小肠镜检查结果。结果①便血患者的常见病因依次为结肠息肉(25.15%),直肠和结肠癌(13.75%),直肠和结肠炎症(10.65%),溃疡性结肠炎(5.11%),憩室病(2.51%),内痔(2.26%),血管发育不良(1.76%)。②结肠息肉(R=0.79,95%CI为0.02～0.06)、直肠和结肠癌(R=0.94,95%CI为0.03～0.05)、憩室(R=0.69,95%CI为0.00～0.02)、血管发育不良(R=0.65,95%CI为0.00～0.02)与年龄呈正相关(P值分别<0.05、0.01)。溃疡性结肠炎(R=0.90,95%CI为—0.03～0.01)与年龄呈负相关(P=0.00)。直肠和结肠炎症、内痔与年龄不相关(P值均>0.05)。结肠和直肠癌与息肉的发生率无显著关联(x~2=0.25,P=0.62)。结论结肠息肉、直肠和结肠癌、直肠和结肠炎症、溃疡性结肠炎、憩室病、内痔及血管发育不良均为便血的主要病因;随着年龄的增长,结肠息肉、直肠和结肠癌、憩室病及血管发育不良所致出血的发生率呈增长趋势,而溃疡性结肠炎所致出血的发生率随着年龄的增长呈下降趋势。结肠和直肠癌发生率与息肉发生率无显著关联。     

不能完成结肠镜检查的原因分析

本研究的目的是分析结肠镜检查不能完成的原因,方法：４６００例结肠镜检查均为本科患者。使用日本Ｏｌｙｍｐａｕｓ生产的ＣＦ－ＩＴ２０Ｉ纤维结肠镜和ＣＦ－ＸＱ２３０电子结肠镜检查,到达结肠末段者４２４４例。用粗完成率和校正完成率比较。结果：粗的完成率为９２．２６％,校正完成率为９６．１３％。不能完成的原因;大便堵塞２２例,结肠疾病１５４例,疼痛不能耐受,肠道过于弯曲１７８例,其他原因２例。粗完成率男性低