鼻胃镜经口临床应用1 020例

自２０００年５月至２００１年５月，我院用ＧＩＦ－１６Ｖ、Ｘ鼻胃镜经口使用，共诊断及治疗多种上消化道疾患者１０２０例，现报告如下。一、资料与方法１、一般情况：１　０２０例患者，男５０２例、女５１８例，年龄为２～８８岁。２、器械：日本Ｐｅｎｔａｘ－ＧＩＦ－１６Ｖ、Ｘ前视式鼻胃镜，视野角１２５。，焦距３～５０　ｍｍ，工作长度９３５　ｍｍ，镜身全长１２７０　ｍｍ，插入部外径５．２　ｍｍ，活检孔道２　ｍｍ，弯曲角上下１８０。、左右１６０。，镜端有一个象束窗、两个导光窗、一个活检孔道，注气、注水通道与活检孔…     

鼻胃镜代替小儿胃镜检查的临床价值

目的 探讨鼻胃镜在儿科消化道疾病诊断中的价值。方法 用成人鼻胃镜对34例各类上消化道病变患儿进行胃镜检查，术前准备同普通胃镜，经鼻或口腔插入。结果 本组18例经鼻插入，16例经口插入。全部病例均能完成上消化道检查。32例（94．12％）检查时基本无反应或仅轻度恶心；2例（5．88％）反应较大，表现为恶心、呕吐；4例发生鼻腔微量出血并发症。结论 鼻胃镜的镜身细，患儿易于忍受，对小儿上消化道疾病的诊断与治疗有一定实用价值。     

鼻胃镜的临床应用价值及评估

目的探讨超细电子经鼻胃镜(简称鼻胃镜)的临床诊断价值及其可行性。方法按照随机抽样的原则,从来我院消化内镜中心行胃镜检查的患者中随机抽取160例,组成超细胃镜经鼻插入组(A组,80例)和普通胃镜经口插入组(B组,80例)。用心电监护仪动态监测其胃镜检查前及检查过程中的收缩压、舒张压、心率及血氧饱和度。结果两组患者的血氧饱和度在胃镜检查过程中均略有降低,但差异无统计学意义(P0.05);两组患者的收缩压、舒张压有变化和心率都加快,但B组的加快更明显(P0.05)。结论鼻胃镜经鼻腔插入不接触舌根,其耐受性更好,安全性更高,有更广泛的临床应用前景。     

经鼻胃镜在肝硬化患者的临床应用

目的探讨经鼻胃镜在肝硬化患者中的临床应用价值。方法 85例肝硬化患者进行了经鼻胃镜检查,术后评估患者反应情况;曾接受经口胃镜检查治疗的患者,评估两种胃镜检查的不良反应程度;评估局部出血并发症与凝血功能、血小板计数的相关性。结果 85例肝硬化患者均完成经鼻胃镜上消化道检查,基本无不适者75例,稍有不适者8例,反应较大者2例;5例患者检查结束后出现鼻出血,占全部人群的5.9%;6例患者略感鼻腔内不适,观察后自行缓解消失。结论经鼻胃镜可完成经口胃镜的诊断功能,术中不适感及术中、术后并发症轻而少,经鼻胃镜适于肝硬化患者常规检查。     

鼻胃镜与普通胃镜对老年患者上消化道疾病诊治的临床对照研究

目的 评价鼻胃镜与普通胃镜应用于老年患者上消化道疾病诊疗的耐受性、临床价值及安全性.方法 对有上消化道疾病的116例老年患者（≥60岁）分别予以鼻胃镜、普通胃镜检查（每组各58例）,对患者胃镜检查前、中、后的收缩压、舒张压、心率、呼吸频率、血氧饱和度及检查过程中的不适反应进行观察.结果 普通胃镜组收缩压、舒张压、心率较检查前有显著性升高,差异有统计学意义（P＜0.05）,血氧饱和度和呼吸频率无明显变化（P＞0.05）;鼻胃镜组患者收缩压、舒张压、心率与检查前比较升高,血氧饱和度及呼吸频率略低于检查前,但差异均无统计学意义（P＞0.05）.鼻胃镜组患者视觉模拟评分法（VAS）痛苦评分低于普通胃镜组,差异有统计学意义（P＜0.01）.结论 鼻胃镜的安全性及耐受性均优于普通胃镜,对于不能耐受普通胃镜检查的老年患者,鼻胃镜不失为一种安全、可行的内镜检查方法.     

经鼻胃镜导丝引导下放置鼻肠管的临床应用

目的总结经鼻胃镜导丝引导下放置鼻肠管的技术方法及经验教训,探讨该方法在临床中的应用价值。方法我科自2007年8月至2011年2月共对104例患者进行了115例次经鼻胃镜鼻肠管放置术及肠内营养支持治疗,记录每例置管时间,计算平均时间,观察术中及术后并发症。结果一次置管成功率为94.78%,6例次需二次置管,全部成功。从插入内镜至完成置管时间一般为5～14min,平均约10min,无腹痛、消化道穿孔、消化道出血等并发症。鼻肠管留置时间15～92d。结论经鼻胃镜导丝引导下放置鼻肠管置管适应症广,耐受性好,操作时间短,成功率高,并发症很少,值得在临床上推广应用。     

经鼻胃镜放置肠梗阻导管治疗粘连性小肠梗阻的临床应用

我们将鼻胃镜经鼻插入28例粘连性小肠梗阻的患者十二指肠降段,经活检孔引入亲水性超滑导丝至空肠,退出鼻胃镜,将肠梗阻导管沿导丝送入空肠上段,充盈前气囊后,观察患者治疗前后症状有无缓解、腹围缩小情况及24 h引流量等指标。结果 显示28例患者均1次置管成功,成功率100%。置管时间为10～35 min,留管时间为3～18 d。术中均无并发症发生。患者临床症状均有不同程度改善;24 h引流量480～1 550 mL,平均885 mL;置管24 h后患者腹围（79.1%±20.3%）显著小于置管前（100%,P〈0.05）。可见经鼻胃镜放置肠梗阻导管简便、易行,治疗粘连性小肠梗阻疗效确切,应作为治疗粘连性小肠梗阻的首选方法。     

单、双弯角旋钮鼻胃镜临床应用

鼻胃镜技术近年来日益受到国内外消化内镜医师的关注,在国内我们较早地开展了该技术,现对我科5016例鼻胃镜诊查和(或)治疗的资料进行总结,报道如下。     

经鼻胃镜检查的临床应用

使用超细胃镜经鼻插入（简称经鼻胃镜）是一种新的胃镜检查方法，我院消化内镜室于2005年3月至2006年2月共进行了125例经鼻胃镜检查，取得良好效果，报道如下。     

一种新型经鼻内镜与普通胃镜的临床对比研究

目的探讨Fujifilm EG-530NW经鼻胃镜的临床应用价值。方法295例接受胃镜检查的患者,按检查序号的随机数字表法随机分成普通胃镜组（172例）和新型经鼻胃镜组（123例）,观察新型经鼻胃镜组的检查情况,并比较两组患者的血压、心率波动情况以及检查过程中的不适程度差异。结果新型经鼻胃镜组获得的图像与普通胃镜组相似,反转观察无盲区且图像清晰。新型经鼻胃镜组无不适或一般不适的比例明显高于对照组（81．3％比68．6％）,差异有统计学意义（P〈0．05）;心率波动亦明显小于普通胃镜组[（7．4±11．6）次／min比（11．t±14．6）次／min],差异有统计学意义（P〈0．05）;而血压波动两组间比较差异无统计学意义（P〉0．05）。在年龄较大患者（年龄〉50岁）中,新型经鼻胃镜组心率、血压波动均显著小于普通胃镜组,差异有统计学意义（P〈0．05）。结论Fujifilm EG-530NW经鼻胃镜可以获得高质量的图像,较普通胃镜更能减轻患者检查时的不适感,并可减少患者心率与血压的波动,尤其对于年龄较大的患者更具有明显优势,更加安全。     

Transnasal endoscopic biliary drainage as a rescue management for the treatment of acute cholangitis

Endoscopic biliary drainage has been established to provide effective treatment for acute obstructive jaundice and cholangitis. A recently developed ultrathin transnasal videoendoscope (TNE) is minimally invasive even for critically ill patients and can be performed without conscious sedation. Transnasal endoscopic biliary drainage (TNE-BD) is performed using a front-viewing TNE with approximately 5 mm outer diameter and 2 mm working channel diameter. Finally, 5F naso-biliary tube or plastic stent are placed. Technical success rates are approximately 100% and 70% for post-endoscopic sphincterotomy or placement of self-expandable metallic stent, and intact papilla, respectively. There are no serious complications. In conclusion, although further cases should be accumulated, TNE-BD and in particular, one-step naso-biliary drainage using TNE may be a useful and novel technique for the treatment of acute cholangitis.     

Transnasal endoscopy: Technical considerations,advantages and limitations

Transnasal endoscopy(TNE) is an upper endoscopy method which is performed by the nasal route using a thin endoscope less than 6 mm in diameter. The primary goal of this method is to improve patient tolerance and convenience of the procedure. TNE can be performed without sedation and thus eliminates the risks associated with general anesthesia. In this way,TNE decreases the cost and total duration of endoscopic procedures, while maintaining the image quality of standard caliber endoscopes, providing good results for diagnostic purposes. However, the small working channel of the ultra-thin endoscope used for TNE makes it difficult to use for therapeutic procedures except in certain conditions which require a thinner endoscope.Biopsy is possible with special forceps less than 2 mm in diameter. Recently, TNE has been used for screening endoscopy in Far East Asia, including Japan. In most controlled studies, TNE was found to have better patient tolerance when compared to unsedated endoscopy. Nasal pain is the most significant symptom associated with endoscopic procedures but can be reduced with nasal pretreatment. Despite the potential advantage of TNE, it is not common in Western countries, usually due to a lack of training in the technique and a lack of awareness of its potential advantages. This paper briefly reviews the technical considerations as well as the potential advantages and limitations of TNE with ultra-thin scopes.     

Transnasal endoscopy: Technical considerations,advantages and limitations简

Transnasal endoscopy (TNE) is an upper endoscopy method which is performed by the nasal route using a thin endoscope less than 6 mm in diameter. The primary goal of this method is to improve patient tolerance and convenience of the procedure. TNE can be performed without sedation and thus eliminates the risks associated with general anesthesia. In this way, TNE decreases the cost and total duration of endoscopic procedures, while maintaining the image quality of standard caliber endoscopes, providing good results for diagnostic purposes. However, the small working channel of the ultra-thin endoscope used for TNE makes it difficult to use for therapeutic procedures except in certain conditions which require a thinner endoscope. Biopsy is possible with special forceps less than 2 mm in diameter. Recently, TNE has been used for screening endoscopy in Far East Asia, including Japan. In most controlled studies, TNE was found to have better patient tolerance when compared to unsedated endoscopy. Nasal pain is the most significant symptom associated with endoscopic procedures but can be reduced with nasal pretreatment. Despite the potential advantage of TNE, it is not common in Western countries, usually due to a lack of training in the technique and a lack of awareness of its potential advantages. This paper briefly reviews the technical considerations as well as the potential advantages and limitations of TNE with ultra-thin scopes.     

非镇静经鼻食管胃十二指肠镜的临床应用

经鼻食管胃十二指肠镜检查是一种新型的上消化道内镜检查技术，能减轻操作时患者的恶心不适感，改善患者耐受性，避免静脉麻醉药的使用，是一种安全、可行的常规内镜检查选择。本文就非镇静经鼻食管胃十二指肠镜检查的操作方法、可行性、耐受性、安全性等作一综述。     

内镜置入鼻空肠营养管两种技术的比较

目的比较鼻空肠营养管的鼻胃镜导丝引导置入技术与内镜下推送式置入技术的临床应用效果。方法2011年6月,选择因胃窦、幽门、十二指肠病变导致狭窄梗阻需要空肠营养治疗的40例患者,分成两组,进行鼻空肠营养管的内镜下常规推送式置入（推送组）与鼻胃镜导丝引导置入（导丝组）,比较操作时间、置入一次性成功以及空肠营养管脱回胃内的情况。结果每组20例患者,均完成内镜鼻空肠营养管置入治疗。推送组与导丝组,操作平均时间分别是（750．3±445．9）S、（157．4±79．3）s,一次性成功率为85％、100％,空肠营养管脱回胃内发生率为30％、0％。两者比较,在操作平均时间上,差异具有非常显著性意义（P〈O．01）。结论置入鼻空肠营养管,鼻胃镜导丝引导置入技术比内镜下推送式置入技术,更具方便、操作简单的优点。