目的 分析Peutz-Jeghers综合征临床特点，以提高诊治水平。 方法 2008年11月-2010年1月对8例Peutz-Jeghers综合征的临床资料进行回顾性分析。 结果 男女各4例，年龄13～41岁，病程20 d～40年。8例均有黑斑和息肉，5例有明确的家族史。首发表现以腹痛为主，轻度抑郁表现2例，并发肠套叠2例，结肠癌1例。病理报告：错构瘤4例。外科手术治疗1例，结肠镜治疗6例，保守治疗1例。 结论 Peutz-Jeghers综合征易并发抑郁症、肠套叠和恶性肿瘤，患者需心理治疗和遗传咨询，肠镜下息肉切除是主要手段。
Objective To evaluate the difference of oral sodium phosphate (NaP) and polyethylene glycol-electrolyte lavage solution (PEG-ELS) in the aspects of cleansing efficacy, tolerance, and safety in clinical practice, so as to provide evidence for clinical practice. Methods A systematic review of all the relevant randomized controlled trials (RCTs) was performed according the handbook of the Cochrane Collaboration. RCTs were identified from The Cochrane Library(Issue1,2004) MEDLINE(1980-2004), EMBASE(1984-2004),and CBM(1978-2004).Handsearching was also performed .RCTs comparing the two methods were selected .Tow reviewers independently assessed the quality of included trials and extracted data independently .Results Eighteen trials involving 3668 patients were included .Sub-group analysis was performed. Nap tablet had higher rate of adequate cleansing quality (RR1.08,95%CI1.02 to 1.05,p=0.01).Two-day ,divided-dose oral Nap was superior in the rate of adequate cleansing quality (RR1.27,95%CI1.06 to 1.52,p=0.009). .The. rate of adequate cleansing quality in right colon of Nap was lower than PEG-ELS(RR0.79,95%CI 0.64 to 0.98,p=0.03).The rate of abdominal cramps (RR 0.84,95%CI 0.72 to 0.99),the rate of abdominal fullness (RR 0.48,95%CI 0.26 to 0.89),the rate of nausea (RR 0.65,95%CI 0.56 to 0.76)and the percentage of patients who didn’t finished their prescribed regimen (RR 0.23,95%CI0.14 to 0.36)in Nap group were lower (plt;0.05).Conclusions Compared with PEG-ELS,Nap is superior in cleansing efficacy , patients’ tolerance ,safety and economy . It is possible to promote the use of Nap in clinical practice in China .
ObjectiveTo systematically evaluate the efficacy and safety of computer-aided detection (CADe) and conventional colonoscopy in identifying colorectal adenomas and polyps. MethodsThe PubMed, Embase, Cochrane Library, Web of Science, WanFang Data, VIP, and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) comparing the effectiveness and safety of CADe assisted colonoscopy and conventional colonoscopy in detecting colorectal tumors from 2014 to April 2023. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias of the included literature. Meta-analysis was performed by RevMan 5.3 software. ResultsA total of 9 RCTs were included, with a total of 6 393 patients. Compared with conventional colonoscopy, the CADe system significantly improved the adenoma detection rate (ADR) (RR=1.22, 95%CI 1.10 to 1.35, P<0.01) and polyp detection rate (PDR) (RR=1.19, 95%CI 1.04 to 1.36, P=0.01). It also reduced the missed diagnosis rate (AMR) of adenomas (RR=0.48, 95%CI 0.34 to 0.67, P<0.01) and the missed diagnosis rate (PMR) of polyps (RR=0.39, 95%CI 0.25 to 0.59, P<0.01). The PDR of proximal polyps significantly increased, while the PDR of ≤5 mm polyps slightly increased, but the PDR of >10mm and pedunculated polyps significantly decreased. The AMR of the cecum, transverse colon, descending colon, and sigmoid colon was significantly reduced. There was no statistically significant difference in the withdrawal time between the two groups. Conclusion The CADe system can increase the detection rate of adenomas and polyps, and reduce the missed diagnosis rate. The detection rate of polyps is related to their location, size, and shape, while the missed diagnosis rate of adenomas is related to their location.
目的 探讨腹腔镜术中联合结肠镜治疗结直肠小占位病变的可行性和临床应用价值。方法对我院2006年12月至2009年5月期间23例行腹腔镜联合结肠镜手术的结直肠小占位病变患者的临床资料进行回顾性分析。结果 所有患者均在腹腔镜下完成手术，无中转开腹。 手术时间80～200 min，平均140 min; 出血80~120 ml，平均100 ml。 9例息肉病变行局灶切除，术中经快速冰冻切片病理证实4例早期癌及10例不典型增生均行相应肠段切除。 术后1例出现轻度肺炎，经积极抗炎对症治疗后痊愈，其余患者恢复良好。 所有患者术后第1天即离床活动，住院时间5～10 d，平均7 d。结论 腹腔镜术中联合结肠镜治疗结直肠占位是安全可行的，有助于结直肠病灶及切缘的准确定位，可缩短手术时间，值得临床进一步推广应用。
ObjectiveTo understand the prevalence of anorectal diseases in the elderly in the community, and to evaluate the role of electronic rectosigmoidoscope in the screening of anorectal diseases.MethodThe resident population aged 60–74 in the Xichang’an Street Area of Xicheng District of Beijing were collected to complete the initial screening by filling in the risk factor assessment questionnaire, and who were classified as the high-risk with positive initial screening were admitted to the diagnostic re-screening by electronic rectosigmoidoscope.ResultsThere were 4 782 screening subjects, while 4 347 people actually participated in the initial screening, and 2 997 people were positive (positive rate was 68.9%). Among them, 2 312 participated in the electronic rectosigmoidoscope screening, and the compliance rate was 77.1%. A total of 2 275 patients with various anorectal diseases were detected by electronic rectosigmoidoscope, 1 311 (56.7%) of whom were hemorrhoids, 458 (19.8%) were rectal polyps, 154 (6.7%) were anal papillary hypertrophy, 147 (6.4%) were proctitis, 103 (4.4%) were anal fissure, 52 (2.2%) were anal fistula , 33 (1.4%) were rectal melanoma , and 17 (0.7%) were suspected rectal cancer. The detection rates of rectal polyps, proctitis, and anal fistula in the men were higher than those in the women (P<0.05), while the detection rates of hemorrhoids, anal papilla hypertrophy, anal fissure, and rectal melanosis in the women were higher than those in the men (P<0.05).ConclusionsAs a screening tool, electronic rectosigmoidoscope has the characteristics of simple operation, good compliance of the subject, and high compliance rate for re-screening. It is suitable for large-scale screening of anorectal diseases for elderly residents in the community.
目的评价胆道镜和十二指肠镜在治疗T管拔除后胆瘘中的应用价值。方法对我院2000年5月至2004年12月期间9例采用胆道镜或十二指肠镜下鼻胆管引流（ENBD）治疗T管拔除后胆瘘患者的资料进行回顾性分析。结果本组病例采用胆道镜和十二指肠镜治疗均获成功，无并发症。结论胆道镜和十二指肠镜治疗T管拔除后胆瘘临床疗效可靠，有推广价值。
ObjectiveTo investigate the importance of nursing observation and intervention for extrahepatic bile duct stones with gallbladder stones treated by electronic duodenoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC). MethodsFrom July 2011 to February 2014, 157 patients with extrahepatic bile duct stones with gallbladder stones underwent EST and LC at the same time in our department. Combined with the surgery characteristics, we focused on the close observation and nursing of postoperative complications and drainage tubes for patients' timely recovery. ResultsOne patient with duodenal diverticulum papilla did not complete EST and LC surgery, which was then transformed to LC, bile duct incision and choledochoscopy with T tube drainage. All the remaining 156 patients completed endoscopic retrograde cholangio-pancreatography and LC with a completion rate of 99.36%. Under close observation and careful nursing care, this group of patients did not have duodenum perforation, bile leakage or other complications. No patient died. Seven to thirteen days after hospitalization, all the patients were cured and discharged from the hospital. ConclusionFor patients undergoing EST and LC at the same time, observation and timely intervention are very important in reducing serious complications, improving the quality of surgery, enhancing patients' comfort, and promoting postoperative recovery.
目的:观察舒芬太尼复合异丙酚自控镇静镇痛在结肠镜检查中的效果及不良反应,从而探讨该方法的安全性和有效性。方法:行无痛纤维结肠镜检查的患者60例,随机分为两组:自控镇痛/镇静组和静脉复合全麻醉组,每组30例。自控镇痛/镇静组首先缓慢静脉注射舒芬太尼0.12 μg/kg,随之接电子自控镇痛泵,负荷量设定为0.5 mg/kg,以4 mg/kg·h的速度持续泵入异丙酚(10 mg/mL),术中按压1次自控手柄可快速推注异丙酚1 mL。静脉复合全麻醉组首先静脉缓慢推注芬太尼1 μg/kg,咪唑安定0.02 mg/kg, 2 min后缓慢推注异丙酚0.8～1 mg/kg。术中间断给予异丙酚以维持听觉诱发电位指数(AAI)于30～40之间。结果:静脉复合全麻醉组的MAP较检查前明显下降且较自控镇痛/镇静组下降更为明显且具有统计学意义(Plt;0.05)。自控镇痛/镇静组的呼吸频率较静脉复合全麻醉组下降明显且在T3时间点具有统计学意义(Plt;0.05)。自控镇痛/镇静组患者OAA/S评分达5分和Aldrete评分达9分的时间均较静脉复合全麻醉组明显缩短(1.4±1.3 VS 3.9±1.7和 2.9±1.7 VS 5.7±1.7)(Plt;0.05)。两组的内镜医师和患者满意度评分无统计学差异(P＞0.05)。结论:自控镇静镇痛能够比传统的静脉全身麻醉提供更良好的循环系统稳定性,更迅速的麻醉后恢复,是结肠镜检查镇静镇痛的理想和安全方法。
ObjectiveTo evaluate the feasibility and efficiency of patient-controlled analgesia and sedation (PCAS) with propofol and remifentanil for colonoscopy in elderly patients. MethodsSixty elderly patients preparing for painless colonoscopy between May and September 2015 were randomly allocated into PCAS group and total intravenous anesthesia (TIVA) group with 30 patients in each. In the PCAS group, the mixture of remifentanil and propofol at 0.6 mL/(kg·h) was pumped continuously after an initial bolus of 0.05 mL/kg mixture. The examination began three minutes after the infusion was finished. Patients could press the self-control button. Each bolus delivered 1 mL and the lockout time was 1 minute. In the TIVA group, patients received fentanyl at 1 μg/kg and midazolam at 0.02 mg/kg intravenously, and accepted intravenous propofol at 0.8-1.0 mg/kg two minutes later. The examination began when the patients lost consciousness. ResultsA significant decline of mean arterial blood pressure was detected within each group after anesthesia (P < 0.05). The decrease of mean blood pressure in the TIVA group was more significant than that in the PCAS group (P < 0.05). The heart rate, pulse oxygen saturation and respiratory rate decreased significantly after anesthesia in both the two groups (P < 0.05), while end-tidal CO2 increased after anesthesia without any significant difference between the two groups (P > 0.05). The induction time, time to insert the colonoscope to ileocecus, and total examination time were not significantly different between the two groups (P > 0.05). As for the time from the end of examination to OAA/S score of 5 and to Aldrete score of 9, the PCAS group was significantly shorter than the TIVA group (P < 0.05). ConclusionPCAS with remifentanil and propofol can provide sufficient analgesia, better hemodynamic stability, lighter sedation, and faster recovery compared with TIVA.
软结肠镜的临床应用在肠道疾病的诊断及治疗上是一大进步，不但能诊断大肠及末端回肠疾病，更重要的是可以用来治疗一些经保守治疗无效的下消化道内科疾病以及一些外科疾病，如肠息肉、肠扭转等需外科手术才能治愈的疾病可用软结肠镜治疗。我们对1987年7月至2001年8月采用软结肠镜诊治的低位肠梗阻、乙状结肠扭转、假性结肠梗阻、下消化道出血、良性肠狭窄及肠道息肉等9 051例需外科处理的疾病加以探讨，以提高软结肠镜在治疗外科疾病中的安全性及疗效。