静脉麻醉辅助大肠镜检查的效果

目的在大肠镜检查中以良好的止痛及镇静作用,增加患者接受检查的依从性,提高检查的成功率。方法将６１９例患者随机分为观察组（３１９例,给予异丙酚及芬太尼静脉麻醉）与对照组（３００例,常规操作）,对２组患者的操作时间、检查成功率、检查反应以及检查前、中、后三阶段的血氧饱和度、心率进行观察。结果观察组操作时间、检查成功率、检查反应等方面明显优于对照组（Ｐ＜０．０１）,检查前后血氧饱和度和心率的变化与对照组比较差异无显著意义（Ｐ＞０．０５）。结论辅以异丙酚及芬太尼静脉麻醉进行大肠镜检查是安全有效的,为无痛苦大肠镜检查开辟了广阔前景。     

门诊患者大肠镜检查的临床意义

目的探讨对有症状就诊人群进行大肠镜检查的临床意义。方法１９９５年～１９９６年对１２４６例因有下消化道症状就诊于消化科的患者进行大肠镜检查。结果肠粘膜炎性改变４３７例，溃疡性结肠炎５５例，息肉１８７例（腺瘤１２１例，增生性息肉６６例），肠癌１１１例，未发现病变４１１例。在１８７例中发现并摘除息肉２９１枚，其中１３例１３枚息肉有局部恶变者电凝摘除后随访１年无异常发现。１１１例肠癌中ＤｕｃｋＡ６０例。腺癌、息肉的检出率与年龄呈正相关（Ｐ＜０．０５），但≤２９岁组腺癌、息肉也分别检出１．８％和１６．４％。结论有症状就诊人群大肠镜检查是一可行、安全、费用不高和省时的方法，能明显减少大肠癌的发病率和死亡率。     

167例急性便血的大肠镜检查结果分析

急性便血临床上常见,但其病因诊断常有困难,特殊检查主要有大肠镜、钡灌肠、血管 造影、核素扫描等,国内对急性便血紧急大肠镜检查的病因统计报告较少,作者对近 15年 在本院作大肠镜检查的 167例急性便血患者资料作分析。 1.材料和方法：所选病例便血突然,为鲜红、暗红或粘液血便,排血总量 >100 ml, 伴心悸、头晕、面色苍白等失血征象,镜检与首次便血时间相隔≤ 2周、与末次便血时间 相隔≤ 72 h,并做胃镜、钡餐或肠系膜血管造影等排除了上消化道出血。内镜下观察到活 动出血,或溃疡糜烂,或充血明显,或血管突起者为出血灶;发现…     

电子大肠镜检查失败原因分析

随着大肠镜的改进和插镜技术的提高,许多大肠疾病的诊治水平有了明显提高,由于插镜是检查成功的关键,所以探讨插镜失败的原因及春预防措施具有重要意义,现就47例电子大肠镜插镜失败病例进行回顾性分析。     

大肠镜检查时心血管功能变化

为探讨大肠镜检查时是否出现心血管系统并发症及采取何种预防措施 ,我们使用动态血压计和动态心电图 ,观察了６２例大肠镜受检者。现将结果报告如下。１．资料和方法 :本组６２例 ,男３０例 ,女３２例 ,年龄２２～７６岁。其中＜５０岁３８例（年龄２２～４９岁 ,平均３６岁） ,≥５０岁２４例（年龄５０～７６岁 ,平均６２岁）。使用美国产动态血压计和国产的ＨＯＬＴＥＲ -ＳＴＡＲ仪监测大肠镜检查中以及检查前、后各１ｈ的血压和心电图变化。血压每３ｍｉｎ测一次 ;心电图记录打印导联为ＣＭ -Ｖ１、ＣＭ -Ｖ３、ＣＭ -Ｖ５。受检者均按…     

213例下消化道出血大肠镜检查分析

我院自1997—04／2001—09对213例以便血为主诉的患者进行大肠镜检查结果分析如下。     

静脉麻醉在大肠镜检查中的应用

大肠镜检查是目前诊断大肠疾病最常用的方法，但检查同时带来一定程度的腹痛、腹胀及其他不适．不少患者难以接受，故我院对大肠镜检查的患者辅以静脉麻醉，并与对照组进行了比较观察，报告如下。     

有症状患者大肠镜检查的临床意义

1997年8月至1999年12月。我院消化科对有下消化道症状的患进行大肠镜检查,现将结果总结如下。     

大肠镜在小儿外科的应用

目的 探讨大肠镜在小儿外科的应用。方法 运用Olympus PCF-20型小儿肠镜诊断与治疗小儿大肠外科疾患776例。结果 共诊治大肠息肉病659例,其中幼年性大肠息肉和幼年性息肉病653例,内镜下YAG激光摘除术或高频电凝切除治疗325例,注射止血剂后镜下摘除法治疗328例,摘除息肉391枚;诊断家庭性息肉病4例;Peutz-Jeghers综合征2例,均在内镜下摘除息肉。诊断先天性巨结肠42例,其中短段型7例,常见型32例,长段型3例,发现合并慢性结肠炎32例,肠息肉6例,肠虫病2例。巨结肠术后随访7例,发现皱譬襞样增生物并盲袋、吻合肉芽肿、肛周脓肿并肛瘘各1例。诊断肠套叠75例,内镜下加压整复70例,失败5例。结论 大肠镜是诊断治疗小儿外科疾患的重要工具。     

大肠镜检查在诊断回肠末端疾病中的临床意义

小肠疾病并不少见，但由于其起病隐匿，症状体征缺乏特异性。目前临床上大多数医院无胶囊内镜和双气囊小肠镜设备，早期诊断小肠疾病十分困难。我们应用大肠镜观察了806例患者回肠末端黏膜情况，现总结报告如下。     

老年人无痛性肠镜检查的研究

目的比较单用丙泊酚组和丙泊酚联合芬太尼组在老年人无痛肠镜检查中的应用效果。方法60岁及60岁以上行结肠镜检查的老年病人100例,随机分为A、B两组。A组为芬太尼和丙泊酚联合用药组,诱导量为芬太尼0.75-1．25μg/kg,丙泊酚0．0-0．8mg／kg。B组为单用丙泊酚组,诱导量为静脉推注丙泊酚0．4-1．5mg/kg。肠镜操作期间监护脑电双频指数（BIS）,SPO2,BP.维持BIS在60—80之间。结果联合用药组达到BIS 60的时间短,血压下降幅度小,虽有明显的呼吸抑制,仍能维持良好的自主呼吸。结论在充分氧供,维持自主呼吸的情况下,丙泊酚联合小剂量芬太尼更适合老年人无痛肠镜检查。     

CASE REPORT OF TRICHOBEZOAR CAUSING GASTRIC PERFORATION

A 17‐year‐old girl with trichophagia (hair eating) habits was admitted to our hospital because of severe acute epigastralgia in June 1997. Abdominal computed tomography showed free air in the abdominal cavity and a heterogeneous mass in the stomach and the duodenum. A perforation on the anterior wall of the lower gastric body was found by urgent laparoscopic surgery and thus a laparoscopic omental patch repair was performed. Endoscopic examination after the operation revealed a large trichobezoar and gastric ulcers. An attempt made by us to extract the bezoar by endoscopy using a flexible outer‐tube was unsuccessful. The gastric ulcer relapsed in November 1997. Another attempt was made to extract the bezoar with laparoscopic instrumentation using a percutaneous gastrostomy port associated with oral gastroendoscopy. Only the part of the bezoar in the duodenum was extracted, and multiple superficial ulcers and erosions in the second part of the duodenum were found. Removal of the entire bezoar in the stomach required surgical gastrostomy. An endoscopic examination after the operation revealed healing of the gastric ulcer and duodenal erosions. Gastric perforation due to trichobezoar is a rare complication. Since the attempt to remove the trichobezoar in a minimally invasive manner failed, a surgical gastrostomy was required.     

CURRENT STATUS IN THE OCCURRENCE OF POSTOPERATIVE BLEEDING,PERFORATION AND RESIDUAL/LOCAL RECURRENCE DURING COLONOSCOPIC TREATMENT IN JAPAN

Bleeding, perforation, and residual/local recurrence are the main complications associated with colonoscopic treatment of colorectal tumor. However, current status regarding the average incidence of these complications in Japan is not available. We conducted a questionnaire survey, prepared by the Colorectal Endoscopic Resection Standardization Implementation Working Group, Japanese Society for Cancer of the Colon and Rectum (JSCCR), to clarify the incidence of postoperative bleeding, perforation, and residual/local recurrence associated with colonoscopic treatment. The total incidence of postoperative bleeding was 1.2% and the incidence was 0.26% with hot biopsy, 1.3% with polypectomy, 1.4% with endoscopic mucosal resection (EMR), and 1.7% with endoscopic submucosal dissection (ESD). The total incidence of perforation was 0.74% (0.01% with the hot biopsy, 0.17% with polypectomy, 0.91% with EMR, and 3.3% with ESD). The total incidence of residual/local recurrence was 0.73% (0.007% with hot biopsy, 0.34% with polypectomy, 1.4% with EMR, and 2.3% with ESD). Colonoscopic examination was used as a surveillance method for detecting residual/local recurrence in all hospitals. The surveillance period differed among the hospitals; however, most of the hospitals reported a surveillance period of 3–6 months with mainly transabdominal ultrasonography and computed tomography in combination with the colonoscopic examination.     

RAPUNZEL SYNDROME WITH GASTRIC PERFORATION IN AN ADULT

Rapunzel syndrome is a rare condition of gastric trichobezoar with contiguous extension in the intestines found commonly in pediatric and teenage patients, mostly females, with underlying psychological disorders. We report the case of a 37‐year‐old widow who presented with epigastric pain, fullness and early satiety of 6 months duration. Investigations revealed a trichobezoar extending from the stomach through the duodenum into the jejunum. Psychiatric analysis revealed depressive symptoms. She was posted for elective surgery; however, 2 days prior to the surgery she presented with acute abdomen with plain X‐ray of the chest and abdomen showing free gas under the diaphragm. Urgent laparotomy was carried out which confirmed the diagnosis of gastric perforation due to Rapunzel syndrome. The perforation was closed primarily along with removal of the trichobezoar en masse by anterior gastrotomy. This is the first case of Rapunzel syndrome with gastric perforation that has presented in the fourth decade of life. Here we discuss the etiology, pathogenesis, diagnosis and treatment of this unusual syndrome.     

青蒿琥酯对家兔预防血吸虫病优化方案的探讨

目的为现场应用青蒿琥酯预防日本血吸虫病制定最佳服药方案提供实验依据。方法设22个试验组按不同给药方案喂服青蒿琥酯,比较各组的减虫率、减雌虫率和治愈率。从而得出最佳的给药方案。结果各种方案以感染后第7天首服青蒿琥酯,剂量为16mg／kg,每周1次,连服4次（反复感染组需连服5次）的给药方案效果最好。减虫率为99．5％（反复感染组为97．0％）。每15d服1次,连服4次（反复感染组需服5次）的给药方案也可行,减虫率达81．4％（反复感染组为79．4％）。为加强10d间隔的2d疗法的效果,我们在末次给药的次日,再加服1次。可明显增强效果,减虫率可由31．1％提高到89．5％。剂量以16mg／kg（相当于临床6mg／kg）为宜,加大剂量并不能增加疗效。同样剂量和疗法对不同感染度的家兔减虫率无明显差异。结论感染第7天开始首服,每周1次,连服4～5次的疗法效果最好。本疗法适宜于重感染度血吸虫病流行区中、短期（2个月之内）接触疫水的人群使用。感染后第15天首服,每15d服1次,连服4～5次的疗法,由于副反应极轻,服用方便,价格经济,故适用于长期接触疫水的人群现场使用。服药剂量以16mg／kg为宜。     

142例先天性胸主动脉缩窄的外科治疗

本文报道142例先天性胸主动脉缩窄外科治疗的经验。本组手术死亡串1.41%,远期疗效优良率95.2%,晚期死亡率1.2%。重点讨论近年来在治疗本病的基本方法、手术方法及移植材料方面的新进展。     

MAGNIFYING COLONOSCOPY FOR THE DIAGNOSIS OF INFLAMMATORY CHANGES IN ULCERATIVE COLITIS

Background: Endoscopic observation is the most effective method for the evaluation of staging in ulcerative colitis (UC). However, in cases with very mild inflammatory activity, histopathological diagnosis may also be required. Unfortunately, biopsy‐related accidents are not uncommon. As an alternative, we have used a magnifying colonoscope commonly used for tumor diagnosis to examine in detail the colon mucosa of UC patients in clinical remission, and then compared these findings relative to conventional endoscopy using histopathological diagnosis. Subjects and Methods: Among UC cases examined by colonoscopy between April 2000 and April 2005, 27 cases without hematochezia for at least 1 month were enrolled in this study. Following observations of inflammatory changes using conventional colonoscopy, magnifying observation and biopsies at a total of 144 sites were evaluated. Using histopathological standards, acute‐phase inflammation was indicated by the presence of neutrophil infiltration, whereas chronic‐phase inflammation was indicated by infiltration of lymphocytes, plasma cells and eosinophils. Results: Indicators of significant inflammation by conventional observation was erosion. Under magnification, inflammation appears as superficial defects in mucosa and small whitish spots. When the presence of infiltrating neutrophils was used as a positive histological marker for inflammation, there was no difference in the accuracy of diagnosis by conventional observation (95.1%) versus magnifying observation (97.2%). In contrast, when lymphocyte infiltration was used as a marker, the accuracy of diagnosis increased significantly (88.2%) using magnifying observation relative to conventional observation (61.1%). Conclusions: Magnifying endoscopy can be used effectively in the evaluation of minute mucosal changes in cases of UC remission.     

EFFICACY OF AN ACCELERATED COLONOSCOPY TRAINING WEEK: AUDIT FROM ONE NATIONAL COLONOSCOPY TRAINING CENTER IN THE UK

Background: Poor performance and inadequate training in colonoscopy in the UK has been reported. Several centers across the UK run intensive hands‐on training courses but their efficacy has not been established. Methods: To assess the benefit of the accelerated colonoscopy training course, an audit was conducted for the 50 trainees who individually attended the course. The course objectives were to increase core knowledge and improve the basic hand skills required for colonoscopy on a one‐to‐one basis. This includes three microteaching, two computer simulator and four hands‐on training sessions within 4 days. They performed two multiple‐choice question (MCQ) papers. Performance parameters measured at the beginning and end of the course were the Direct Observation of Procedural Skills (DOPS) using visual analog scales for all aspects of colonoscopy technique. Results: The MCQ score significantly increased: mean score 57%vs 66% (P < 0.0001). DOPS demonstrated an improvement in clinical skills. Pre‐ and post‐course mean scores were: general approach 75 vs 81 (P = 0.007), basic handling technique 59 vs 67 (P = 0.002), understanding and control of looping 54 vs 67 (P < 0.0001), cecal/ileal intubation 61 vs 76 (P < 0.0001) and extubation technique 65 vs 77 (P < 0.0001), respectively. All trainees had a high level of satisfaction and found the hands‐on training most beneficial. Conclusion: This intensive course improves core knowledge and clinical skills in colonoscopy, which maximizes hands‐on training, which may accelerate the learning curve.