Using computed tomography colonography in patients at high risk of colorectal cancer – a prospective study in a university hospital in South America

OBJECTIVES:

The purpose of our study was to report the results of the implementation of computed tomography colonography in a university hospital setting serving a Brazilian population at high risk of colorectal cancer.

METHODS:

After creating a computed tomography colonography service in our institution, 85 patients at high risk of colorectal cancer underwent computed tomography colonography followed by a same-day optical colonoscopy from September 2010 to May 2012. The overall accuracy of computed tomography colonography in the detection of lesions ≥6 mm was compared to that of optical colonoscopy (direct comparison). All colonic segments were evaluated using quality imaging (amount of liquid and solid residual feces and luminal distension). To assess patient acceptance and preference, a questionnaire was completed before and after the computed tomography colonography and optical colonoscopy. Fisher''s exact test was used to measure the correlations between colonic distension, discomfort during the exam, exam preference and interpretation confidence.

RESULTS:

Thirteen carcinomas and twenty-two lesions ≥6 mm were characterized. The sensitivity, specificity and accuracy of computed tomography colonography were 100%, 98.2% and 98.6%, respectively. Computed tomography colonography was the preferred method of investigation for 85% of patients. The preparation was reported to cause only mild discomfort for 97.6% of patients. According to the questionnaires, there was no significant relationship between colonic distension and discomfort (p>0.05). Most patients (89%) achieved excellent bowel preparation. There was a statistically significant correlation between the confidence perceived in reading the computed tomography colonography and the quality of the preparation in each colonic segment (p≤0.001). The average effective radiation dose per exam was 7.8 mSv.

CONCLUSION:

It was possible to institute an efficient computed tomography colonography service at a university hospital that primarily assists patients from the public health system, with high accuracy, good acceptance and effective radiation doses. Our results seem to be comparable to other centers of excellence and fall within acceptable published guidelines, showing that a successful computed tomography colonography program can be reproduced in a South American population screened in a university hospital.     

运动干预联合咀嚼口香糖在结肠镜检查肠道准备中的应用研究

目的探讨运动干预联合咀嚼口香糖对服用复方聚乙二醇电解质散(PEG)进行肠道准备患者的肠道准备质量及不良反应的影响。方法选取2017年6月-2018年6月在我院消化内镜室行结肠镜检查前肠道准备的患者300例为研究对象,采用随机数字表法将其分为联合组、口香糖组和对照组,各100例。对照组在检查当日提前4~6 h服用PEG等渗溶液2000 mL,每10 min服用250 mL,2 h内服完,并嘱患者多运动;口香糖组在对照组基础上按要求每服用250 mL,咀嚼无糖口香糖1粒,持续10 min,共8颗;联合组在口香糖组基础上在嚼口香糖同时持续步行10 min,速度达到50步/min及以上。采用Boston量表评价3组患者的肠道清洁度,记录患者首次排便及大便排空时间,记录操作时间及不良反应发生情况。结果共291例患者完成研究,联合组右半结肠、横结肠、左半结肠BBPS评分、BBPS总分及祛泡效果评分均高于口香糖组及对照组(P<0.05);联合组首次排便时间、大便排空时间、插镜时间短于口香糖组及对照组(P<0.05);联合组及口香糖组恶心、呕吐、腹胀发生率低于对照组(P<0.05),联合组腹胀发生率低于口香糖组(P<0.05)。结论运动干预联合咀嚼口香糖可提高服用PEG肠道准备患者的肠道准备质量,缩短肠道准备时间及操作时间,减少不良反应的发生率。     

佳苏仑在无痛内镜术中的应用效果

目的 观察佳苏仑用于无痛内镜检查中的应用效果.方法 随机双盲抽取接受无痛肠镜及无痛胃镜检查患者120例,分为异丙酚组(I组)和佳苏仑组(Ⅱ组),每组60例,I组麻醉时缓慢静脉注射异丙酚,Ⅱ组加用佳苏仑.观察两组的麻醉效果及对呼吸循环的抑制程度.结果 两组的麻醉效果无明显差异(P>0.05),但Ⅱ组对呼吸的抑制程度明显低于I组(P<0.01).结论 在静脉注射异丙酚进行的无痛内镜诊疗中,联合使用佳苏仑能有效减少呼吸抑制作用,提高患者无痛内镜检查的安全性,同时不影响麻醉效果.     

变换体位多排螺旋CT结肠成像筛查结肠息肉性病变的研究

目的对比研究多排螺旋CT结肠成像变换体位扫描在检查结肠息肉性病变的应用价值。方法收集2011年3月-2015年12月共39例具有同期常规结肠镜检和多排螺旋CT结肠镜成像术检查患者,每例患者在CC检查前不超过2周时间内都进行了HD750 CTC检查,以CC检查为标准共发现189枚结肠息肉,其中28例135枚息肉在CC检查过程中进行了电凝切除及病理。全部病例CTC检查均采用仰卧位和俯卧位两个体位进行检查。结果单独仰卧位CTC检查发现了203枚结肠息肉性病变,而单独俯卧位发现了199枚。联合仰卧位和俯卧位图像评估共发现185枚结肠息肉性病变,与CC检查结果基本相符,所遗漏的4枚结肠息肉均为直径小于5mm病变。结论多排螺旋CT结肠成像变换体位扫描(仰卧位和俯卧位双体位扫描)在筛查结肠息肉性病变具有很高的敏感度,与金标准CC检查结果大致相符,完全能够满足临床诊断要求,可以为及时有效的治疗及预后随访提供准确可靠的影像依据。     

内镜下黏膜染色加黏膜切除对大肠侧向发育肿瘤的诊断治疗

目的探讨电子肠镜下靛胭脂黏膜染色联合黏膜切除对大肠侧向发育肿瘤（LST）诊治的临床价值。方法对4200例肠镜检查中发现的可疑黏膜病灶，行镜下喷洒0．4％靛胭脂黏膜染色，镜下观察病灶大小并形态分型，病灶黏膜可随充吸气变形者及黏膜下注射液体黏膜抬举征呈阳性者行内镜黏膜切除（MER）或分片黏膜切除术（EPMR），未能行黏膜切除者行镜下活检，病灶黏膜送病理检查。结果发现45例患者共47个LST病灶，检出率为l、l％。分型；颗粒型33（70．2％）和非颗粒型14（29、8％）。大小；10～19mm25个（53．2％），20～30mm14个（29．8％），〉30mm8个（17．0％）。病理检查黏膜局部癌变7例（5例SM癌，2例sML癌），LST病灶中早期大肠癌捡出率为14．9％，进展期大肠癌3例，良性腺瘤37个（78．7％）。结论普通电子肠镜结合黏膜染色能够有效的发现大肠LST病灶，联合镜下黏膜切除根除LST病灶对早期大肠癌防治具有积极临床意义。     

无痛肠镜检查误吸致ARDS死亡1例分析

无痛技术在临床诊疗中的应用日益广泛,误吸等严重并发症的防治亦需引起高度重视。本例说明,无痛肠镜检查中应注意气道保护以防范误吸的发生,而早期诊治则是误吸抢救的关键。