摘要
目的 探讨以结肠镜单人操作为基础的透明帽辅助下全结肠注水交换法在临床的应用价值。方法 收集2014年9月3日至2019年9月3日在盘江总医院就诊的门诊病人及住院进行结肠镜检查的患者12573例的数据。所有患者完全无镇静镇痛的清醒状态。以透明帽辅助注水交换单人结肠镜操作的患者为试验组，以普通结肠镜单人操作注气组为对照组。比较两组成功插管至回肠末段的例数、时间、镜身长度、患者疼痛评分、并发症的发生情况。结果 透明帽辅助全结直肠注水交换组99.81%（7900/7915）成功插管进镜至回肠末段、仅0.019%（15/7915）未到达回盲部，普通结肠镜单人操作注气组90.00%（4192/4658）成功插管进镜至回肠末段、10.00%（466/4658）未到达回盲部。两组相比，透明帽辅助全结直肠注水交换组进镜到达回肠末端时间更短，到达回肠末端镜身长度更短、患者疼痛评分更低，回肠末段插管成功率更高，内镜诊疗并发症更低，且差异具有统计学意义（P＜0.05）。两组均无严重并发症发生。结论 透明帽辅助注水交换单人结肠镜广泛适用于难以实施常规结肠镜且存在较多结肠镜检查并发症风险的患者。在无镇静镇痛完全清醒状态下，可以安全高效地实施结直肠至回肠末段检查及介入治疗。本技术在结直肠早癌筛查、结直肠疾病的精细诊断和内镜介入治疗具有广泛推广的临床应用价值。
关键词： 单人结肠镜；透明帽；注水交换
Abstract
Objective To explore the clinical application value of the transparent cap-assisted total colonic water exchange method based on colonoscopy single operation. Methods Data were collected on 12,573 outpatients and hospitalized patients undergoing colonoscopy at Panjiang General Hospital from September 3, 2014 to September 3, 2019. All patients were completely awake without sedation and analgesia. The patients with transparent cap assisted water injection exchange single colonoscopy operation were the experimental group, and the ordinary colonoscopy single operation gas injection group was the control group. The number of cases, time, lens length, pain score, and complications of successful intubation to the end ileum between the two groups were compared. Results 99.81% (7900/7915) of the transparent cap assisted by the total colorectal water exchange group were successfully intubated to the terminal ileal segment, only 0.019% (15/7915) did not reach the ileocecal part, 90.00% (4192/4658) of the ordinary colonoscopy single operation gas injection group were successfully intubated to the terminal ileum, and 10.00% (466/4658) did not reach the ileocecal part. Compared with the two groups, the transparent cap-assisted total colorectal water exchange group had a shorter time to reach the end ileum, a shorter length of the lens body to reach the end of the ileum, a lower pain score, a higher success rate of terminal ileal intubation, and lower complications in endoscopic diagnosis and treatment, and the difference was statistically significant (P<0.05). There were no serious complications in either group. Conclusion Clear cap-assisted water exchange single colonoscopy is widely used in patients who are difficult to perform conventional colonoscopy and are at risk of colonoscopy complications. In the fully awake state without sedation and analgesia, colorectal to terminal ileal examination and interventional therapy can be performed safely and efficiently. This technology has widely promoted clinical application value in early colorectal cancer screening, fine diagnosis of colorectal diseases and endoscopic interventional treatment.
Key words： The single operation of colonoscopy; Transparent-cap; Water injection exchange
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