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1、结肠镜单人操作技术临床应用的探讨真诚为您服务【摘要】 目的 探讨结肠镜单人操作技术的临床应用。方法 对2004年11月至2008年12月笔者采用结肠镜单人操作技术施行全结肠检查与治疗的618例患者的资料进行回顾性分析。结果 结肠镜单人操作检查治疗成功609例，成功率98.5%，回盲部到达率96.9%，末端回肠到达率55.5%;到达回盲部时间为550min，平均13 min;进镜长度一般为5080cm,少数为80100cm，个别在100cm以上;行肠镜下息肉切除(EMRL)80例，肠镜下行乙状结肠套叠伴扭转复位成功1例，无1例并发症发生。结论 结肠镜单人操作技术安全、简便、成功率高，患者痛苦小，
2、值得临床推广。 【关键词】 结肠镜;单人操作Abstract Objective To investigate the clinical application of the technique of oneman colonoscopy. Methods The data of 618 patients who were examined and treated with the technique of oneman colonoscopy from November 2004 to December 2008 were analyzed. Results 609 patients wer
3、e successfully examined and treated with oneman colonoscopy, and the rate of success was 98.5%. The rate of reaching cecum was 96.9%, the rate of reaching the end of ileum was 55.5%. Thirteen minutes on (average from five to fifty minutes) was used for reaching ileocecum. The length of the scope rea
4、ch to the cecum was commonly from fifty to eighty centimeters, minority were from eighty to one hundred centimeters, exceptionally over one hundred centimeters. Polypectomy were performed in eighty cases and one case with sigmoid volvulus and intussusception was successfully treated by colonoscopy,
5、with no complications. Conclusion Oneman colonoscopy not only is safety, simple and convenient, but also has a high success rate and reduces patient pain, therefore is clinically worth popularizing.Key words Colonoscopy; Oneman结肠镜是检查结直肠肠疾病可靠、有效的检查方法,双人操作曾是国内外普遍采用的经典方法, 自从日本消化内镜专家工藤进英创立“轴保持短缩法”以来,结肠镜
6、单人操作技术日趋完美，因其操作安全、简便、患者痛苦小、成功率高、患者反应良好、又节省人力，已被发达国家广泛采用，成为国际上结肠镜插入法的主流技术，国内仅有少数医疗单位和个人采用，远未普及。笔者于2004年11月开始开展结肠镜单人操作检查与治疗,至今完成618例次,无1例发生并发症。现将有关资料总结报告如下。1 资料和方法1.1 临床资料 2004年11月至2008年12月采用结肠镜单人操作法行全结肠检查与治疗的患者共618例次。其中男406例次,女212例次,年龄1689岁,平均41.5岁。临床表现为腹痛、腹胀、腹泻、便血、黏液便、黏液脓血便、便秘、腹部不适、腹部包块等。其中有3例是直肠癌mi
7、les术后患者。1.2 肠道准备 术前1 d低渣饮食,术前晚进流质,检查当日早8时予甘露醇500 mL和葡萄糖盐水1000 mL口服，在2 h内饮用完毕。少数肠道清洁不佳的患者给予清洁灌肠。对行息肉切除的患者采用硫酸镁和口服补液盐水作肠道准备。1.3 操作方法 采用OlympusGIF260型电子结肠镜进行操作。患者取左侧卧位,术者左手持结肠镜角度操作部,右手握住镜身前端进镜。基本要领:根据结直肠走向协调内镜旋转度与角度操作,循腔进镜,抽气为主,以退求进。保持内镜与肠壁间的适当距离,适时钩拉、抽气、左右旋镜。必要时变换患者体位和助手腹部按压防止镜身结圈。保持镜身拉直、肠管短缩状态。术者左右手密切配合,协调动作,完成进镜过程。
