基层医院开展电子结肠镜检查及治疗的临床体会

Clinical experience of primary hospital on developing electronic colonoscopic examination and treatment in primary hospital

目的探讨基层医院开展电子结肠镜检查及治疗的技巧和注意事项。方法对2608例电子结肠镜检查及治疗的病人进行总结。结果其中检出大肠息肉304例,占12%;结肠、直肠癌181例,占7%;溃疡性结肠炎78例,占3%;克罗恩病2例,占0.08%;缺血性结肠炎3例,占0.12%;慢性结肠炎360例,占14%;镜下微创治疗肠息肉300例、结肠癌10例,占12%,放置结肠内支架5例,占0.2%,开展无痛肠镜检查860例,占33%。其中1例病人结肠息肉术后发生迟发性肠穿孔,行急诊肠修补手术治疗;肠出血3例,均经内科保守治疗配合镜下电凝、微波或1:10000去甲肾上腺素局部喷洒后出血停止,其余病人均未见并发症发生。结论只要认真学习上级医院的先进经验,术前彻底清洁肠道,掌握进镜技巧,谨慎诊断和治疗,严防并发症,就能开展好电子结肠镜检查及治疗。

[Objective] To discuss the skill and precautions of developing electronic colonoscopic examination and treatment in primary hospital. [Methods] The data of 2608 patients undergoing electronic colonoscopic examination and treatment were summarized. [Results] Among all the patients, 304 patients（12%） had colorectal polyps, 181（7%） had colon cancers and rectal cancers, 78（3%） had ulcerative colitis, 2 （0.08%） had crohn＇s diseases, 3 （0.12%） patients had isehemic colitis, 360 （14%） had chronic colitis. 300 patients with intestinal polyps and 10 patients with colon cancers accepted endoscopic minimal invasive treatment which occupied 12%, 5 patients accepted operations of placing colon stents occupying 0.2%, 860 patients underwent painless colonoscopy occupying 33%, wherein 1 patient had delayed intestinal perforation after colonic polyps operation and accepted emergency intestinal repair operation, 3 patients had enterorrhagia which was stopped through conservative medical treatment matched with endoscopic electric coagulation and microwave or through locally spraying 1：1000 norepinephrine, and other patients did not have complications. [Conclusion] Electronic colonoscopie examination and treatment can be well developed through earnest study of advanced experience of superior hospitals, thorough intestines cleaning before operations, mastery of colonoscopy entering skills, cautious diagnosis and treatment, and strict prevention of complications.