电子肠镜定位下腹腔镜辅助结肠息肉切除10例临床分析

目的：探讨电子肠镜定位下施行腹腔镜辅助结肠息肉切除的手术方法及注意事项。方法：回顾分析10例电子肠镜定位下施行腹腔镜辅助结肠息肉切除患者的临床资料,对手术方法及注意事项进行探讨。结果：本组10例患者均痊愈出院。平均手术时间为（75.00±19.58） min;平均术中出血为（37.00±9.49） ml;平均首次肛门排气时间为（38.40±15.02） h;平均住院时间为（8.20±0.79） d。随访6～12个月未见复发。定位点与息肉基底部所在的肠管横断面距离最短0 cm,最长6 cm。镜下仅1例隐约有息肉影,其余9例均看不到息肉影。定位点有6例偏向息肉近侧,2例偏向远侧,2例在准确位置上。结论：电子肠镜定位腹腔镜辅助结肠息肉切除是安全可行的方法;但一般不能看到明确的息肉影,仅靠光感定位及器械触碰与肠镜观察配合定位,术中适当调整肠镜光强度和镜头角度并注意双镜配合,可获较准确的定位效果。     

磷酸钠盐口服溶液在结肠镜检查前肠道准备中的应用

目的 观察磷酸钠盐口服溶液清洁肠管的效果和不良反应.方法 应用磷酸钠盐口服溶液进行结肠镜检查前肠道准备,136例患者随机分为对照组和观察组,对照组口服聚乙二醇电解质散,观察组口服磷酸钠盐口服溶液.观察用药过程中排便情况,肠腔清洗效果和气泡存在情况,比较服药前后3 d便性状及次数,记录不良反应.结果 131例患者完成观察...     

丙泊酚和咪唑安定复合哌替啶在门诊结肠镜检查中的比较研究

目的比较丙泊酚和咪唑安定复合哌替啶在门诊无痛结肠镜检查中的临床效果和安全性。方法将80例拟行无痛结肠镜检查患者随机分为P组（丙泊酚1.5 mg/kg）和MM两组（咪唑安定0.05 mg/kg＋哌替啶1.5 mg/kg）,观察患者给药前、插镜时、睁眼时的血压、心率、血氧饱和度,记录麻醉期间的不良反应例数、肠镜检查时间、清醒时间以及VAS疼痛评分。结果两组患者麻醉过程中各时相点血压、心率、血氧饱和度差异均无统计学意义（P〉0.05）;P组肠镜检查时间和清醒时间均短于MM组,差异有统计学意义（P〈0.05）;P组VAS评分低于MM组,差异有统计学意义（P〈0.05）。结论丙泊酚和咪唑安定复合哌替啶均可很好地完成门诊无痛结肠镜检查,而丙泊酚相对来说更具优点,值得推广。     

咪哒唑仑联合氧化亚氮吸入麻醉在结肠镜检查中的应用

目的 探讨咪哒唑仑联合氧化亚氮吸入麻醉在结肠镜检查中的可行性和安全性.方法 108例均应用咪哒唑仑与氧化亚氮吸入麻醉行结肠镜检查,观察并记录给药前、给药后、检查第3分钟及退镜后心率(HR)、收缩压(SBP)、舒张压(DBP)和脉搏血氧饱和度(SpO2)的变化.结果 给药后、检查第3分钟及退镜后各项观察指标与给药前比较差异无统计学意义(P>0.05);Ramsay镇静评分2级以上占94.4%.提示镇静和镇痛效果好.结论 咪哒唑仑联合氧化亚氮吸入麻醉用于结肠镜检查过程中各项生命体征平稳,安全有效.     

武汉地区目标人群结直肠癌筛查4年初步报告

目的 了解武汉地区结直肠癌的患病率,探索并分析开展城市居民恶性肿瘤二级预防的措施和序贯粪隐血筛检试验（SFOBT）方案的应用。方法采用整群分层随机抽样,选取19个筛查点的63961人作为目标人群,连续4年对筛查对象（40岁以上者）进行SFOBT,对阳性者行结肠镜精筛。结果目标人群中的筛查对象25837例（40．4％）,接受SFOBT者7784例（30．1％）,男女比例1．0：1．1．中位年龄56岁。SFOBT阳性者956例（12.3％）,其中240例（25．1％）接受结肠镜检查,检出有病变者214例（89．2％）,其中结直肠癌14例（6．5％）,TNMⅠ、Ⅱ期11例,占检出结直肠癌的78．6％;结直肠腺瘤53例（24．8％）;直肠炎75例（35．0％）;溃疡性结肠炎5例（2.3％）;痔和肛门疾病65例（30．4％）;胃癌2例（0．8％）。结论武汉地区40岁以上人群结直肠癌的患病率为6．5％,SFOBT方案能比较有效地从目标人群中检出早期结直肠癌和癌前病变。     

Endoscopic management of postoperative stapled colorectal anastomosis hemorrhage

Rectal bleeding following colorectal anastomosis is common but usually self-limited. Continuous hemorrhage is rare, and when it occurs, often requires further treatment. The most frequently used strategies for treatment of stapled anastomotic hemorrhage are clinical observation with or without blood transfusion, rectal packing, angiographic identification of the bleeding site with vasopressin infusion or embolization, and endoscopic eletrocoagulation. We report the case of a 49-year-old man with uncomplicated diverticular disease who was treated by laparoscopic sigmoidectomy, with double-stapled colorectal anastomosis. Six hours later, the patient presented intense rectal bleeding and was taken to the operation room for urgent colonoscopic examination. After complete removal of blood clots inside the rectum, a bleed localized at the anastomotic site was identified and submucosal peri-anastomotic injection of 10 ml adrenaline (1:200 000) in saline was performed with immediate bleeding control.     

The cleansing result of oral sodium phosphate is inversely correlated with time between the last administration and colonoscopy

Background There is some evidence that the timing of sodium phosphate (NaP) ingestion affects the cleansing result. The objective of this study was to evaluate the correlation of cleansing result with the timing of ingestion of NaP. Methods 214 consecutive outpatients scheduled to undergo colonoscopy were enrolled in the study. All patients filled out a detailed questionnaire concerning the execution of bowel cleansing. Concomitant with colonoscopy, patient characteristics were recorded and after the procedure the cleansing result was scored. The correlation between cleansing score and time from the last dose of NaP to colonoscopy was evaluated. For further analysis, patients were divided into three groups regarding the time lag from NaP taking to colonoscopy (group 1, 6 h or less; group 2, 6–12 h; group 3, 12 h or more). Results 204 patients had complete colonoscopy and enough data to be analyzed for the study. The Pearson correlation coefficient for the time between the last dose of NaP and colonoscopy was -0.450 (p=0.0001) showing an inverse correlation. The mean cleansing score (±SEM) of group 1 was 4.00±0.12, for group 2 it was 3.56±0.12, and for group 3 it was 2.64±0.14. There were statistically significant differences between all groups. Conclusion The cleansing result of NaP is inversely correlated with the time between last dose of NaP and colonoscopy. Colonoscopy should be preferably performed within 12 hours of taking the second dose of NaP.     

Frequently overlooked and rarely listened to： Music therapy in gastrointestinal endoscopic procedures

To elucidate the role of music therapy in gastrointestinal endoscopic procedures following the conflicting outcomes reported in two recent studies. The findings of our recent meta-analysis that examined this matter were discussed in the context of later studies. Our meta-analysis illustrated the beneficial effects of music therapy on patient anxiety levels when used as a single measure of relaxation and analgesia. Beneficial effects were also shown on analgesia and sedation requirements and procedure duration times when used as an adjunct to pharmacotherapy. These findings are in agreement with those of both studies excluded from analysis and those that followed it. Music therapy is an effective tool for stress relief and analgesia in patients undergoing gastrointestinal endoscopic procedures.     

Inflammatory fibroid polyp occurring in the transverse colon diagnosed by endoscopic biopsy

A case of an inflammatory fibroid polyp occurring in the transverse colon and diagnosed by endoscopic biopsy is reported. The patient was an 82-year-old man who visited our hospital for further evaluation of occult blood in stool. The Colonoscopy revealed a small, red, and peduncular polyp, about 6 mm in diameter, in the transverse colon. Histological examination of the biopsy specimen obtained from the polyp revealed proliferation of fibroblasts and infiltration of inflammatory cells such as plasma cells and eosinophils. This polyp was diagnosed as an inflammatory fibroid polyp, which can appear in many different locations throughout gastrointestinal tract, though still rare in the transverse colon.     

复方聚乙二醇电解质散在结肠镜检查前肠道准备的临床观察

目的：评价口服复方聚乙二醇电解质散在结肠镜检查前肠道准备的效果和安全性。方法：将61例行结肠镜检查及治疗的患者随机分为研究组及对照组。研究组口服复方聚乙二醇电解质散清洁肠道,对照组口服甘露醇清洁肠道。对肠道清洁的效果、患者服药后的不良反应及耐受性进行比较。结果：研究组肠道清洁度、不良反应发生率及耐受性方面均优于对照组。结论：口服复方聚乙二醇电解质散清洁肠道效果佳、安全性好,是临床患者结肠镜检查前肠道准备的理想方法。