纤维结肠镜检查一万例无并发症的分析

Experience of 10 000 cases of colonoscopy without complications

目的：探讨纤维结肠镜（纤镜）的插镜方法及肠内外因素对插镜的影响，预防并发症。方法：纤镜达乙状结肠１０ｃｍ后就开始逐步取直镜身，不用见腔就进镜，待结圈后才取直镜身。同时随访剖腹术前行纤镜检查的患者，探讨进镜困难的表现及进镜方法。对肠道行端侧等吻合术后有多个腔的患者，根据粪水来自的方向及大、小肠粘膜的不同特点，可正确判断正常通道，防止纤镜误入盲端。结果：纤镜检查１万例，插镜达盲肠成功率９８．８％，无并发症。结论：掌握了找腔难、进镜阻力增加、进镜镜后退及滑进镜头不前进等进镜困难和解剖变异的表现，及取直镜身进镜法后，可加快进镜速度，提高插镜成功率，有效预防并发症。

Objective:To prevent complications, the methods of inserting colonoscope and influence of the inside and outside intestinal factors on inserting colonoscope were studied. Methods: After passing through sigmoid 10 cm, the body of colonoscope was gradually straightened. There was no need to move forward the colonoscope after seeing the lumen and straighten the colonoscope after the loop was formed. At the same time the patients were followed up who underwent colonoscopy before laparotomy. The expression of difficulties in and methods of moving forward colonoscope were analyzed. For the patients who had several lumens after side to end anastomosis, according to the direction of stool fluid and characteristics of large and small intestinal mucosa, the normal pathway was identified correctly and entering into blind bottom was prevented. Results: In 10 000 cases of colonoscopy, successful rate of reaching cecum was 98.8% and there was no complications. Conclusion: Knowing well the expression of anatomic variations and difficulties in inserting colonoscope, such as finding lumen, increasing of resistance, moving backward and not moving forward of the colonoscope, and grasping the methods of straightening the body of colonoscope can heighten the speed of inserting colonoscope, raise the successful rate and prevent complications effectively.