小儿便血全麻下成人型结肠镜诊治

目的:探讨使用成人型结肠镜对全身麻醉下的小儿便血患者进行同步病因诊断和治疗的临床应用价值。方法:回顾性地对40例便血患儿全麻下的成人型结肠镜检查和治疗资料进行分析。结果:全部患儿顺利进行了诊断及治疗,37例明确诊断,确诊率为92.5%。病变以大肠息肉最多30例,炎症病变6例,大肠钩虫症1例。大肠息肉全部分布于直肠和乙状结肠分别为22例及8例。除1例直肠息肉"自截"脱落遗留残根外,其余息肉全部一次性高频电圈套摘除。术后即发出血1例,迟发出血1例。麻醉意外1例。术后随防,1例多发性息肉患儿术后1年余复发。结论:儿便血主要原因为大肠息肉,且位于直肠者居多;成人型结肠镜应用于2岁以上小儿是安全可靠的,且具诊断和治疗双重作用;据小儿结肠息肉大多分布在直肠、乙状结肠的特点,插镜深度达全乙状结肠为宜;全身麻醉为小儿成人型结肠镜检查和治疗的顺利进行提供良好态势;治疗性镜检术后卧床休息十分重要。

Diagnosis and treatment of hematochezia of children using adult colonoscopy under general anesthesia

Objective: To assess the diagnosis and treatment of hematochezia of children using adult colonoscopy under general anesthesia.Methods: Datas of 40 pediatric patients with hematochezia diagnosed and treated using adult colonoscopy under general anesthesia were studied retrospectively.Results: All patients had successfully undergone colonoscopy for diagnosis and treatment;37 cases had established diagnosis,accounting for 92.5%.The lesions including colorectal polyps in 30 cases,inflammation in 6 cases,ancylostomiasis in 1 case.The locations of colorectal polyps were 22 cases in rectum and 8 cases in sigmoid colon.The colorectal polyps were removed using high-frequency electric trap apart from one case with stubble of rectal polyp after self shedding.Postoperative immediate bleeding in 1 case,delayed bleeding in 1 case.anesthesia accident in 1 case.One patient with multiple polyps recurred a year and more later by follow-up.Conclusion: The major cause of pediatric hematochezia was colorectal polyps,which located mostly in the rectum.Adult colonoscopy is safe and reliable for two-year-old and more children for the diagnosis and treatment of colorectal polyps.The optimal site of installation of the colonoscopy is the sigmoid colon according to the locations of polyps and the anatomy of children.General anesthesia may provide suitable condition for children undergoing diagnosis and treatment with adult colonoscopy.