结肠镜在结直肠外科疾病中的诊治

Study of colonoscopy diagnosis and treatment of surgical diseases of colonrectum

目的探讨应用结肠镜（内镜）对常见结直肠外科疾病的诊治，以提高利用内镜进行诊治的安全性及疗效。方法回顾2001～2005年间1231例行内镜诊治的病人，其中行内镜治疗76例，包括大肠息肉62例、乙状结肠扭转4例、假性结肠梗阻5例及急性结肠出血5例。总结操作体会，分析疗效及并发症的原因。结果内镜下治疗62例大肠息肉，共132枚，无并发继发性出血及迟发性穿孔。21例结肠梗阻病人行内镜检查，19例明确梗阻原因及部位。对4例乙状结肠扭转行内镜下复位，3例成功，另1例经二次复位后仍复发，予以手术治愈。对5例假性结肠梗阻行内镜下减压，随访3个月，4例治愈。5例急性结直肠出血，4例发现出血灶，4例内镜下止血成功。结论内镜提高了结直肠外科疾病的诊治水平，创伤小，应用中要严格掌握适应证，改进操作技术，减少并发症。

Objective To discuss the use of colonoscopy in surgical disease of colon rectum and improve colonoscopic safety and efficiency in the diagnosis and treatment. Methods From 2001 to 2005,1231 cases were diagnosed and treated by colonoscopy in our department. Among them, 76 cases,including 62 cases of intestinal polyp,19 cases of colonic ileus,4 cases of sigmoid volvulus,5 cases of colonic pseudo - obstruction ,5 cases of acute colon rectum bleeding,were treated by colonscopy. Results Colonoscopic polypectomy was perfomed in 62 cases of colorectal polyp （total 132 polyps）, without complications; causes and sites of lower ileus in 19 cases were ascertained;sigmoid volvulus in 4 cases was replaced;colonic pseudo -obstruction in 5 cases was healed by colonoscopic decompression;causes and sites of acute colon rectum bleeding in 5 cases ascertained, and in the meantime bleeding was stopped in 4 case. Conclusion Colonoscopy can improve diagnostic and therapeutic level for diseases of colon rectum,but doctors must know indications.