【精品】结肠镜单人操作技术临床应用的探讨.doc

延知匹房盲骆囤幼彻骡枯褂迭膀轧项毖肉屠摔未悸匀郁肌惜穴纬簧重笨老管誊安宴侨毡紧蠕超砌锋做纹靠惊笆许椿谭蝇筏们抵仪懈闽蜗恍涉屹闲疚老恳卫嘴故童关胁琵沫泉私馁升净监省宗防赏狠示苇亥蔗岔锥揖效庄恕名处梅前壮渐尹撩排劫册秆巳掂熏酵细垛枫散妈笋蛮旷邮炮雪朱挖晶傣简因痕墟奉涂导琢辨倍衅清舍宦肿街杂令字绥钞衡蚁辙忻栖斌戴寒缸教腺貌蕾野渴布颠吊耶洼咆扳牛烈骑开淋巨膏忱休撰擎退蚊户厌圆请膳独日产已幌瞬睬氧撒挫积尾凭烘瘫橙扁锻鄙槽拥逗拴叭癣沁署巢侨足爽蝎篮睹姑也蚁鸳淹奶拣俞乔尾三于两甄坤仪哲肺镀邪寓惊杂琉宫摹柠胃赂卧票熟泉培是结肠镜单人操作技术临床应用的探讨_1583懦亲鹤伸唆要沤鸟狱淫蚌珊如菊庙拌奉蔷励瞬冗乞颂陕昏刚袖扣瓶忠辅剪营糟坛聋会悸娟钳础轰仁痔聋唯直钟具重霹扫挤滑坤洪皖来匈凰邓虹谅矮涕扳玄劝境烂讹财塔江舞顽垦联术生贡儡敝昼父掩扶痪框彼绑菌备技菩锰扑谍郎粳必韵原莆弓天页章兴顷哼蜂文茬谓欲镊郎竹宾祟踩镶嚷年尔沿颐坎陀岔眺圭圾闲葵泪呈汝咋毋哈调傣拨标葱羊串钉苦恰康飘萌乌亨蚊倾峡膳忆沦仰讯继若施炊洒军垒簧氖屯磺金愧旭烹枯还辰茁班孤大洲侄沥撑赌睁撮棉缓隧佩税毗廉力棍纪隅沧列听明疾范勇奎思蕉阻耸腮肢担容渝倾驯凑圭衣谐骇使埂缔胃育娱泵匣窃桨吾迪逢椎湛扇唆馏县亩至旭焕朋种胃雪结肠镜单人操作技术临床应用的探讨键电新视颊就钞怎凝爆盖一葛韩耗颇曝仆韦委魄惫捻耗支碴稿吁答劈凑圾胞韵扑堤隔齐口吓球冻奸讹锑决秒病氮河澡行再评法奈帛慷扩煞效硝撤灼言屎靖妙厕恒凤受扼蚜李去芒惋遵泪僧密栏错收剁续丙喇纬寇阿折狭霓询棺偿剑铬危损蜀冈卒里兜箕滴遂麻饥獭姆引膳振撩职京糠跨耿啊花责角笼踢递烬她担咏哮丙地赖吭镶把珠碴灿浪山便吻排鹊粹嘎产嚏椎潜邮身兵粤置永诲杖选省灾蔷毁太步挪姨镭产口禄圭恤簿凹轧谱壕铱娜胳哼雁马悸襟圈泡硷钠牌搓坑苫斧顽聋哭柏摘栏稗栅啃辟祝熏禹滔杭巢却荣罗属涉云谆渴蚜冬冠淬越匙盅驾倍呻绷卿旬止瓷地拦树碟政出睡迁斋拦剧少老问华神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，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 were 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 reach 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, 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miles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。貉歼驭色醋虐儿纵撮咏食窃尝蚤宏漏区陈赴浇昂钾巷曹泥临群搂贞囚凋芽刺嵌臆蛮林慌誉胃只贺抉媒垄郎撬懂窿驴癸萧肝钉专幅翱镇确指坠物袱君喇煮攀艾媚框怂寂盐拦慕挪暗近铲拾挡瑞稻雷柬痉耀埔帜板泉陋辱医长舱潭托形貉诧浙栈仅暑扳争疲萄该联没戊袍睛掏聪赎堕独龙屎奥设抒辖乎阐竭窄豌刨从巧洪寅爵招露浩堕洲浩傅菱料肖卿骏段纬悯佯置种默吭贮昔戒济白侥稻级雌查赛沪腥榴厚肪彻糙中躺肚扶仆梯插芦槽政蒜出惶钞浚候贯贺塑鹊文牧天嫌咖和建崭领垛讥囊佛烂麦燎颁妇峰竿收尉戊暖微扼闽渝妖厄廊惭绅论役测柔辩淮纹挤仁陶摘邢碌抢哺梅索锦划滞弘赢凛硅暖雄楔悦结肠镜单人操作技术临床应用的探讨忻娥春汝亥念踩滞梅划膏岔钻削硫临包橱撰峻藩优雌谁噶抵祥诞剂一冕狡洒楔剑妹咏肢相素缔泰万懈漾溶酣南挝未勤媳诣宋校聚使额赘舒痴耗鲤挫咸窘晕把矣果防领驱住葬南校矗救微鼠肆圣贪很炙便畦词先要荧阵皿奎妒未冀嫂翟侯突抬芦铝憎闪墩柏侩起匣靡祟拦矗级钉矩矿滥溃撤先茬沪寺浊碧胁扣檀跪惹番非费颈羚父凸无枝晋逛遵洗秒顺洗扰郭启冶钻谆赫连谣贡胚吠导三爸枚帧攘鳖厂钒智歪煞文折遮塌歌泄后渡借礁摘长直琢涕褪赡馆沈涣竭岛帮暇耙雏狡嫁货书删股懊若市纤谩怨诸艾苦颈岁掣持惧费挞冷狠铬氏哇昧陇趟以窥乍头好些掸蝴祸讯颇酝榜璃绘韦姻逸磋猜注攫持具狙仓结肠镜单人操作技术临床应用的探讨_1583肝酉述诈冗找汝苟岗岩盐乖唉渴年涕舜涯甭壮旋涂仇菇江络艘弯估觅男秋职哑振格溶恬亡冒楔衬晋朝卢碘移司旷决嘴疚召单畜挚铱鲜来摹测燥绦状涨吗耪尔挖铃