2019版《中国消化内镜诊疗相关肠道准备指南》解读

随着内镜技术的发展和普及,肠镜检查的重要性进一步突显,肠道准备作为肠镜检查的前提条件显得尤为重要。为进一步改进我国内镜检查前肠道准备的方法,提高内镜检查的质量,结合我国实际情况,中国医师协会内镜医师分会消化内镜专业委员会联合中国抗癌协会肿瘤内镜学专业委员会对旧版指南进行了更新。本文对2019版《中国消化内镜诊疗相关肠道准备指南》的更新内容进行解读,以期更好地加深内镜医护人员对《新指南》的认知和理解,指导患者进行肠道准备,从而最大程度提高肠镜诊疗效果,更大程度的使患者获益。     

Effectiveness of a colonoscopic screening programme in first‐degree relatives of patients with colorectal cancer

Aim The study aimed to assess the diagnostic yield of a colonoscopy screening programme in first‐degree relatives of colorectal cancer (CRC) patients and to identify factors associated with advanced neoplasia. Method We conducted a cross‐sectional study. Individual characteristics, family trees and colonoscopy findings of asymptomatic first‐degree relatives of CRC patients were collected. The findings were classified into cancer (invasive carcinoma and/or non‐invasive high‐grade neoplasia), high‐risk adenomas (≥ 10 mm and/or a villous component) and low‐risk adenomas (tubular < 10 mm). The dependent variable was the presence of advanced neoplasia, defined as cancer and/or high‐risk adenoma. Results Two hundred and sixty‐three relatives (147 females), 50.0 ± 11.5 (range, 25–75) years of age, agreed to participate out of a total of 618 who were invited (acceptance rate 42.5%). Index cases were diagnosed at 63.8 ± 12.4 (range, 37–88) years of age. The closest familial relationship was parent/offspring in 168 (63.9%) participants and sibling in 95 (36.1%) participants; 14.8% had three or more relatives with CRC/cancer associated with Lynch syndrome, and two or more affected generations were identified in 24.0%. Advanced neoplasia was found in 56 (21.3%) participants. Of these, invasive cancer, non‐invasive high‐grade neoplasia and high‐risk adenomas were detected in five (1.9%), six (2.3%) and 45 (17.1%) participants, respectively. Low‐risk adenomas were detected in 20 (7.6%) participants. Male sex (odds ratio, 2.59; P = 0.003) and sibling relationship (odds ratio, 2.74; P = 0.001) were independently associated with advanced neoplasia. Conclusion We detected advanced neoplasia in a considerable number of participants. Our data support colonoscopy screening in first‐degree relatives of patients with CRC at an earlier age than in the medium‐risk population. Male sex and sibling relationship were predictors of advanced neoplasia.     

CT结肠成像对炎症性肠病的诊断价值

目的:探讨CT结肠成像(CTC)在炎症性肠病(IBD)诊断中的价值。方法:回顾性分析我院经结肠镜活检病理证实的7例IBD的CTC资料并文献复习。结果:7例IBD中克罗恩病(CD)4例、溃疡性结肠炎(UC)3例。4例CD的CTC主要表现为病变呈多节段性,病变段肠壁明显增厚、强化,病变段管腔狭窄,导航下病变段肠壁黏膜面凹凸不平呈鹅卵石状,肛周及回盲部周围脓肿并瘘道形成。3例UC的CTC导航下见整个直结肠黏膜面弥漫分布多个浅表溃疡灶,溃疡部位黏膜面毛糙、肠壁轻度不规则增厚、肠壁轻到中等度强化。结论:CTC可多方位、多角度观察肠壁、肠腔或肠外病变,形成整体的二维、三维结肠影像,为临床提供比结肠镜更丰富的信息,对IBD的诊断有其独特的优越性。     

情感安抚策略对于行电子结肠镜下息肉摘除术患者其负性情绪、疼痛程度及应激指标的影响

摘要：目的 探究情感安抚策略对于行电子结肠镜下息肉摘除术患者其负性情绪、疼痛程度及应激指标的影响。方法 选取我院于2014年2月~2016年2月收治的76例行电子结肠镜下息肉摘除术患者,以随机数字表作为分组手段,将纳入对象划分为研究组和对照组各38例。其中对照组开展常规护理干预,研究组则在对照组基础上引入情感安抚策略。记录两组患者在入院时、术前1d及退镜后15min的收缩压、心率值;记录两组患者在入院时、术前1d及术后1d的焦虑自评量表（SAS）和抑郁自评量表（SDS）评分;记录两组患者在入院时、术前1d及术后1d的视觉模拟疼痛评分。 结果 在入院时,两组患者的收缩压及心率值比较无统计学差异（P>0.05）;术前1d及退镜后15min的收缩压及心率值均低于对照组,差异有统计学意义（P<0.05）。在入院时,两组患者的焦虑及抑郁情绪评分差异无统计学意义（P>0.05）;术前1d及退镜后15min的焦虑及抑郁情绪评分均低于对照组（P<0.05）。两组患者在入院时的视觉模拟疼痛程度评分无统计学差异（P>0.05）;术前1d和术后1d的视觉模拟疼痛程度评分均低于对照组（P<0.05）。结论 情感安抚策略应用于行电子结肠下息肉摘除术患者,有助于改善其不良情绪,还能降低其疼痛程度及生理应激相关指标,取得较为可观的临床成效。     

内镜筛查及切除息肉病理检查在早期大肠癌诊断中的意义

为探讨临床内镜筛查及切除息肉病理检查在早期大肠癌诊断中的价值，总结分析了北医大三院１９７８年至１９９６年９月所有大肠镜检查的资料。１８年间行大肠镜检查１８１２３例、内镜下息肉切除２３４５例，共发现早期大肠癌８０例、８６个癌灶，占同期发现大肠癌总数的１５．１％（８６／５６９）。早期大肠癌的诊断率呈上升趋势，特别是１９８７年开展临床内镜筛查以来升高尤为显著。相关分析显示早期大肠癌的诊断率与内镜检查特别是内镜下息肉切除后的病理检查密切相关，提示该两项方法为诊断早期大肠癌的有效方法。     

Cancer surveillance in ulcerative colitis: critical analysis of long-term prospective programme

BACKGROUND: Patients with longstanding ulcerative colitis are at increased risk of colorectal cancer. In the literature, no agreement has yet been reached regarding prevention strategies. Our report sums up a prospective study started in 1980. METHODS: A total of 65 patients affected by ulcerative colitis for more than seven years were admitted to a regular colonoscopic and biopsy follow-up programme. RESULTS: Some 20 years after the beginning of the study, 23 (35.3%) patients have been operated upon, 2 patients have died but not from cancer 29 (44.66%) patients have abandoned the programme. Only 11 (16.9%) patients have remained under colonoscopic surveillance. CONCLUSION: These results cast some doubts on the significance of such a programme and on its long-term feasibility.     

Predicting Colonoscopy Screening Behavior and Future Screening Intentions for African Americans Older than 50 Years

Abstract

African Americans experience a disproportionate burden of morbidity and mortality from colorectal cancer, which may be due to low adherence to screening recommendations. Previous studies have found relationships between decision-making factors and screening behavior, but few have looked at both cognitive and affective factors or within a specifically African American sample. To better understand determinants that drive screening behavior, this study examines affective, cognitive, and social variables as predictors of colonoscopy in an age-eligible African American population. Participants completed surveys assessing affective associations with colonoscopy, perceived benefits and barriers, self-efficacy, knowledge, fear of colonoscopy, perceived risk, and colorectal cancer worry and fear. Regression analysis was used to model decision-making constructs as predictors of screening behavior/intentions. Affective, cognitive, and health care experience variables predicted colonoscopy completion and intentions. Provider-level factors and previous cancer screenings predicted prior screening only, but not intentions. Affective and cognitive components of perceived risk were associated with decreased likelihood of colonoscopy behavior, but increased likelihood of colonoscopy intentions. These findings suggest that colonoscopy decision making involves a complex array of both cognitive and affective determinants. This work extends our knowledge of colorectal cancer screening decision making by evaluating the effects of these multiple determinants on screening behavior in an African American sample. Future work exploring the interplay of affect and cognitions as influences on colonoscopy decision making and how health care experiences may moderate this effect is needed to develop effective intervention approaches and reduce screening disparities.     

经结肠镜钳道直视下联合X线监视置入金属 支架治疗胃十二指肠恶性梗阻38例

目的 探讨经结肠镜钳道（钳道直径3.8 mm）直视下置入金属支架治疗胃十二指肠恶性梗阻的操作方法及疗效。方法 该组38例胃十二指肠恶性梗阻患者在联合 X 线监视经结肠镜钳道直视下,置入42枚金属内支架治疗。结果 38例患者支架置入均获得了成功,随访期间患者均能进食流质或普食,呕吐减轻,生活质量提高,未出现严重并发症。结论 经结肠镜钳道直视下联合 X 线监视置入金属内支架治疗胃十二指肠恶性梗阻,安全有效,操作简便、时间短,患者痛苦小,定位准确,支架一次性置入成功率高、覆盖病变完全,同时利用现有的大钳道结肠镜,不需要购置特制的大钳道胃镜,充分利用了设备资源,适合推广应用。