单人操作结肠镜检查中的护理配合技巧

结肠镜是诊断直、结肠疾病最直接和可靠的检查方法，临床上已得到广泛的应用。结肠镜的插镜技术分双人操作法和单人操作法[1]，我院于2008年开始开展单人操作结肠镜检查，至今已完成检查近15000例。在单人操作结肠镜检查过程中，熟练的护理配合对检查成功及减轻患者痛苦起到关键性作用。2010年1月～2013年7月间共行单人操作结肠镜检查的8451例，现将检查时的护理配合技巧介绍如下。     

护理干预对肠镜插镜成功的效果评价

目的探讨采取护理干预对肠镜检查插镜成功的效果。方法将253例肠镜检查者分为实验组(n=137)和对照组(n=116),对照组按常规接诊指导,实验组在常规基础上给予护理干预,如饮食、用药指导、访视、医护插镜配合等干预手段。比较两组肠道清洁度和耐受度。结果实验组肠道清洁度和耐受度均较对照组高,两组差异具有统计学意义(P0.05)。结论积极的护理干预对于提高肠镜插镜成功率,减少患者不适感,均具有重要的意义。     

注水肠镜改善退镜时肠道清洁度的随机对照研究

目的采用随机对照试验,比较注水肠镜与传统注气肠镜退镜时的肠道清洁度,探讨注水肠镜的优势。方法选择行非麻醉肠镜检查患者222例,随机分为注水肠镜组(A组)112例和注气肠镜组(B组)110例,比较退镜时肠道清洁度评分与退镜-进镜评分,同时对比患者疼痛评分、肠镜达盲肠时间、插镜深度、全结肠检查率、结直肠腺瘤检出率、操作者主观难易度及检查相关并发症等多项指标。结果 A组退镜清洁度评分明显高于B组[M(8)/IQR(1)vs M(8)/IQR(2),P=0.000],A组退镜-进镜清洁度评分明显高于B组[(0.53±0.74)vs(0.23±0.55),P=0.000],并且A组患者腺瘤检出率(ADR)高于B组(36.61%vs23.64%,P=0.041),A组患者术中腹痛评分明显低于B组[M(2)/IQR(1)vs M(4)/IQR(2),P=0.000];A组操作者主观评价明显优于B组[M(1)/IQR(1)vs M(2)/IQR(1),P=0.005],两组患者在达盲时间、插镜深度和全结肠检查率等方面比较,差异无统计学意义。结论注水肠镜显著改善退镜时的肠道清洁度,同时提高ADR,减轻患者不适感,并且不增加达盲时间。     

无痛双气囊推进式电子小肠镜检查的护理与配合

目的探讨静脉全麻下双气囊推进式电子小肠镜检查的护理与配合。方法对98例有消化道症状的患者,在静脉麻醉状态下,辅以适当的护理配合,应用双气囊推进式电子小肠镜检查。结果所有患者插镜成功率100％,检查过程中均未出现明显并发症。结论双气囊推进式小肠镜在麻醉状态下进行检查,并辅以适当的护理配合,可直视检查全小肠腔病变,是一种安全、可靠的诊断和治疗小肠疾病的方法。     

温水灌注法在困难结肠镜检查中的应用研究

目的研究温水灌注法对困难结肠镜检查中的成功率、插镜时间、操作难易度及患者耐受度等方面的影响。方法非麻醉结肠镜检查的排便困难、肠易激综合征(IBS)和既往有盆腔/腹部手术史患者200例,随机分为温水灌注组(实验组)和传统注气法组(对照组),比较两组患者插镜成功率、插镜时间及患者耐受程度等方面的差异。结果 200例患者完成实验,均未发生肠穿孔等并发症。实验组的全结肠检查成功率、达盲时间、操作者满意度和再检意愿均明显高于对照组(P0.05)。在腹部按压和体位变换使用率、腹痛评分方面,实验组明显低于对照组(P0.05)。两组息肉检出率差异无统计学意义(P0.05)。结论温水灌注肠镜能有效提高困难肠镜的患者耐受度、加快插管进程,提高工作效率,是一种理想的进镜法,值得推广。     

无痛双气囊电子小肠镜检查的护理配合

目的通过全麻下对不明原因小肠疾病患者行双气囊推进式电子小肠镜检查,评价其安全性,总结护理要点。方法2006年4月-2007年7月共对117例有消化道症状,经胃镜、结肠镜、全消化道钡餐、腹部血管造影等检查无阳性发现且无肠粘连及严重脏器功能不全的患者,在全身麻醉状态下,应用双气囊推进式电子小肠镜检查,视患者病情决定经口侧或经肛侧检查。结果117例患者插镜成功率100%,其中49例仅行口侧检查,33例仅行肛侧检查,另有35例行双侧检查。检查过程中均未出现明显并发症。结论双气囊推进式小肠镜可直视检查全小肠腔病变,在麻醉状态下进行检查,并辅以适当的护理配合,能够成功完成检查,是一种安全、可靠的诊断和治疗小肠疾病的工具。     

无痛双气囊电子小肠镜检查的护理配合

目的 通过全麻下对不明原因小肠疾病患者行双气囊推进式电子小肠镜检查,评价其安全性,总结护理要点.方法 2006年4月-2007年7月共对117例有消化道症状,经胃镜、结肠镜、全消化道钡餐、腹部血管造影等检查无阳性发现且无肠粘连及严重脏器功能不全的患者,在全身麻醉状态下,应用双气囊推进式电子小肠镜检查,视患者病情决定经口侧或经肛侧检查.结果 117例患者插镜成功率100%,其中49例仅行口侧检查,33例仅行肛侧检查,另有35例行双侧检查.检查过程中均未出现明显并发症.结论 双气囊推进式小肠镜可直视检查全小肠腔病变,在麻醉状态下进行检查,并辅以适当的护理配合,能够成功完成检查,是一种安全、可靠的诊断和治疗小肠疾病的工具.     

小儿纤维结肠镜检查的护理

总结了66例小儿纤维结肠镜检的护理体会。根据小儿特点采取与成人不尽相同的护理方法,包括术前肠道准备、生理盐水灌肠法与甘油灌肠剂灌肠法的效果比较;术中配合,对不合作小儿使用氯胺酮麻醉的插镜配合、病情观察及处理,较大儿童做好心理护理,减少病儿痛苦,保证检查顺利完成。     

手术中肠镜检查在腹腔镜结肠切除的应用

目的探讨腹腔镜结肠切除手术中结肠镜检查的方法、适应证及其安全性和应用价值。方法回顾分析2008年1月至2010年12月为28例患者行完全腹腔镜结直肠切除术,于术中应用了结肠镜检查进行病灶定位的临床资料。结果全部病例均能完成全结肠检查,能明确找到并定位病灶,为腹腔镜病灶肠段准确完全切除除缩短时间,减少并发症发生。结论肠镜腹腔镜"双镜联合"技术的应用,可使腹腔镜结肠切除术术中病灶定位更精确,手术时间缩短,更加安全可靠。     

老年患者行无痛肠镜检查的护理

总结64例老年患者实施无痛肠镜检查的护理。认为检查前做好心理护理、饮食护理、肠道准备和药物、器械准备,检查中密切观察生命体征、有无躁动症状和配合插镜检查,检查后做好病情监测与护理,能保证无痛肠镜检查的安全和有效。     

Streptococcus bovis septicemia and large bowel neoplasia

Streptococcus bovis septicemia is a relatively uncommon entity that is associated with an increased incidence of colonic neoplasms. Three of four patients with S. bovis endocarditis subsequent to septicemia underwent colonoscopy. The fourth patient underwent a barium enema and a proctoscopic examination. Polyps were found in three patients, and adenocarcinoma of the colon in one. Patients with S. bovis endocarditis should be considered at high risk for colonic neoplasms. Screening colonoscopy is recommended for these patients, and follow-up colonoscopy may be warranted.     

单中心就诊中老年人群结肠癌结肠镜筛查结果研究

目的探讨于该院就诊的中老年人群结肠癌结肠镜筛查结果。方法研究对象为2015年1月-2017年12月在该院进行结肠癌筛查的40～74岁人群共96 352例,通过危险度评估与粪便免疫法粪便潜血试验进行结肠癌初步筛查,将初步筛查为高危人群的对象判定为初筛阳性,进行结肠镜进行精筛确诊,对有病变者取组织活检,组织活检结果作为判定金标准,分析筛查结果。结果 96 352例参与筛查的人群中,初步筛查阳性者5 078例,占5.3%;96 352例参与初筛的人群中,男47 153例(48.9%),女49 199例(51.1%),而1 212例肠镜检查的人群中,男668例,女544例,接受肠镜检查的男性与女性比较,差异无统计学意义(22.6%vs 25.7%,P0.05),其中40～49岁占15.0%,50～59岁占28.9%,60～69岁占40.8%,70～74岁占15.3%。5 078例初步筛查阳性者中,1 212例接受结肠镜检查,结肠镜顺应率23.9%。结肠镜筛查中,男性结肠息肉、结肠炎和结肠癌的发生率明显高于女性,差异均有统计学意义(P 0.05),结肠镜筛查中,不同年龄组结肠息肉、结肠炎和结肠癌的发生率比较,差异均有统计学意义(P 0.05),结肠息肉和结肠癌的发生率随着年龄的升高呈上升趋势,而结肠炎的发生率则呈下降的趋势。1 212例行结肠镜检查的人群中,共检出结肠癌30例,占2.5%,其中早期结肠癌14例(46.7%),中晚期结肠癌16例(53.3%);早期结肠癌中,男9例(64.3%),女5例(35.7%),不同性别之间差异无统计学意义(P0.05)。结论该院就诊中老年人群结肠镜筛查结果显示,男性结肠息肉、结肠炎、结肠癌的发生率明显高于女性,结肠息肉和结肠癌的发生率随着年龄的升高呈上升趋势。     

Changing concepts of colonic polyps: clinical and radiographic implications

The relationship of colonic polyps to carcinoma of the colon provides a basis for their importance. Recent advances in the detection of colonic polyps, including double contrast barium examination and colonoscopy, have provided a method for more extensive study of colonic polyps. Studies using these newer techniques indicate that many traditional concepts of colonic polyps were inaccurate. The relationships of polyp size to histology, polyp location to age, and the phenomenon of colon polyp clustering are important to both the immediate treatment of the polyp and to the long-term follow-up of the patient. The use of hemoccult stool screening as a technique for screening for colonic pathology is also of significance to the radiologist. The changing relationships of various parameters of colon polyps bring into question the utility of many of the currently recommended screening procedures for colon pathology. Undoubtedly, this will impact on the practice of radiology.     

综合护理干预在结肠镜检查中的应用

目的:探讨综合护理干预在结肠镜检查中的应用效果.方法:将120例需行结肠镜检查的患者随机分为实验组和对照组各60例,对照组采用常规护理,实验组在此基础上加综合护理.结果:实验组在检查过程中,腹痛和紧张恐惧程度、不良反应、肠镜前端达到回盲部的时间、检查成功率均优于对照组(P＜0.05).结论:综合护理干预在结肠镜检查中明显减轻患者腹痛程度,减轻紧张、恐惧心理,减少并发症的发生,缩短检查所需时间,能有效提高检查成功率.     

Colonoscopy and the barium enema: a radiologic viewpoint

Adherents of colonoscopy are recommending that it replace the radiologic examination as the initial diagnostic study of the colon. We present the radiologic view, supporting the barium enema as a more practical approach to initial diagnostic evaluation. The radiologic examination is an equally reliable, less costly, and much safer method for detecting colonic disease.     

超声在儿童结肠息肉诊断中的应用价值

目的探讨超声对儿童结肠息肉的诊断价值及其超声声像图特征。方法回顾性分析342例术前进行超声检查并经结肠镜及病理证实的结肠息肉患儿的超声表现。结果 342例患儿中男244例,女98例。224例(65.5%)患儿发病年龄为3～6岁。单发息肉333例,位于乙状结肠226例,直肠41例,余段结肠66例。多发息肉9例,共33枚。息肉最大5.3cm×1.7cm×3.1cm,最小0.6cm×0.5cm×0.5cm。超声诊断332例(97.1%),超声表现均为中等回声结节,其内部可探及小囊腔且CDFI血供丰富,可探及蒂血流及息肉内部树枝状血流。<1cm的息肉囊腔及蒂结构不明显,但CDFI可探及明确的血流信号。16例患儿超声检出合并继发肠套叠,表现为同心圆征象,套入起始部肠腔内可探及息肉回声。其中14例患儿息肉位于降结肠及结肠脾曲。结论超声诊断儿童结肠息肉方便、无创、无放射性且检出率高,是血便患儿首选检查方法。结肠息肉超声声像图具有特异性,不易与其他病变混淆,在儿童一般不需鉴别诊断。     

The role of sigmoidoscopy and colonoscopy in the diagnosis and management of lower gastrointestinal disorders: technique,indications, and contraindications

Flexible sigmoidoscopy and colonoscopy have revolutionized the clinical management of colonic diseases. Colonoscopy has a broad range of indications, including evaluating lower GI symptoms such as lower GI bleeding, evaluating abnormal radiographic findings, and screening and surveillance for colon cancer. Colonoscopy is increasingly being used therapeutically. Patient evaluation, patient instructions, and colonic preparation before colonoscopy are essential for safe and efficient colonoscopy. Intravenous sedation reduces patient pain and anxiety during colonoscopy, but requires monitoring by pulse oximetry and automated measurements of vital signs. An experienced colonoscopist can complete colonoscopy in 90% or more of cases, using maneuvers to maintain the colonic lumen in view, straighten the colonoscope, and avoid looping during colonic intubation.     

The extent of successful colonoscopy: A second assessment using modern equipment

Records of 200 consecutive and unselected colonoscopies were reviewed to determine both the success in viewing the entire colon and the average extent of colon visualized, using the most modern equipment. Colonoscopy was completed to the cecum or ileum in 82.5% of studies, and an average of 93.8% of the colon was viewed. These data show considerable improvement compared to those previously reported by us. However, the significant number of incomplete colonoscopies still suggests that colonoscopy and barium enema examination must remain complementary for maximum detection of colonic lesions.     

Benign colorectal neoplasms undetected by colonoscopy

This retrospective investigation assessed the sensitivity of colonoscopy for the detection of colonic polyps seen previously at barium enema examination. Included in the study were 77 patients with 106 polypoid lesions. Films showing lesions not subsequently seen at colonoscopy were reviewed and only those lesions with a visible point of attachment, exhibiting no movement in response to filling or change in position of the patient, and confidently diagnosed as a polyp by both reviewing radiologists were included among the 106 lesions. Sixteen lesions (15%) seen radiologically were not located colonoscopically, indicating an endoscopic sensitivity of 85%. Contrary to previous reports, most of the lesions missed endoscopically were in the left colon in regions thought to have been traversed by the instrument. The 15% false-negative rate found for colonoscopy is consistent with existing reports on colonoscopic errors and is approximately the same as the false-negative error rate for radiologic detection of colonic polyps.     

Evaluation of the PillCam Colon capsule in the detection of colonic pathology: results of the first multicenter, prospective, comparative study

BACKGROUND AND STUDY AIMS: Population-based screening for colorectal cancer is widely recommended, with conventional colonoscopy considered to be the preferred diagnostic modality. However, compliance with screening colonoscopy is low and manpower capacity is limited. Capsule endoscopy might therefore represent a desirable alternative strategy. PATIENTS AND METHODS: The PillCam Colon capsule endoscope was prospectively tested in a multicenter setting. The indications for endoscopy in the enrolled patients included colorectal cancer screening (43 %), postpolypectomy surveillance (26 %), and lower gastrointestinal signs and symptoms (31 %). Study subjects underwent colon preparation and then ingested the capsule on the morning of the examination, with conventional colonoscopy being performed the same day. The PillCam Colon capsule findings were reviewed by three experts in capsule endoscopy who were blinded to the conventional colonoscopy findings. RESULTS: A total of 91 subjects were enrolled in three Israeli centers (55 men, 36 women; mean age 57), and the results were evaluable in 84 cases. The capsule was excreted within 10 hours in 74 % of the patients and reached the rectosigmoid colon in the other 16 %. Of the 84 evaluable patients, 20 (24 %) had significant findings, defined as at least one polyp of 6 mm or more in size or three or more polyps of any size: 14/20 (70 %) were identified with the capsule and 16/20 (80 %) were identified by conventional colonoscopy. Polyps of any size were found in 45 patients, 34/45 (76 %) found by the capsule and 36/45 (80 %) by conventional colonoscopy. In comparison with conventional colonoscopy, false-positive findings on PillCam Colon capsule examination were recorded in 15/45 cases (33 %). There were no adverse events related to the capsule endoscopy. CONCLUSIONS: PillCam Colon capsule endoscopy appears to be a promising new modality for colonic evaluation. Further improvements in the procedure will probably increase capsule examination completion and polyp detection rates. Additional studies are needed to evaluate the accuracy of PillCam Colon endoscopy in other patient populations with different prevalence levels of colonic disease.