短透明帽结肠镜法在单人结肠镜中应用的前瞻性随机对照研究

The efficacy of a short transparent hood attached to the tip of the colonoscope： a single-center, randomized, controlled study

目的探讨短透明帽辅助单人结肠镜操作的临床应用价值。方法对行结肠镜检查且符合纳入标准的160例患者，随机数字表法分成透明帽组（80例）和对照组（80例），由2位肠镜技术中级医生完成检查，并记录体质量指数、有无手术史、肠镜开始时间、到达回盲部时间、结束时间、肠道清洁程度、检查结果、通过回盲瓣尝试次数及患者舒适度等。结果透明帽组73例到达回盲部，到达回盲部时间（7．5±4．0）min；对照组76例到达回盲部，到达回盲部平均时间（9．8±4．5）min，2组到达回盲部时间差异有统计学意义（P=0．011）。透明帽组有3例未能进入回肠末端，其余70例通过回盲瓣平均次数为1．32次；对照组有8例未能进入回肠末端，其余68例通过回盲瓣平均次数为1．96次。2组通过回盲瓣平均次数差异有统计学意义（P=0．001）。透明帽组和对照组息肉检出率分别为32．88％（24／73）和28．95％（22／76），组问差异无统计学意义（P〉0．05）。结论对于中级结肠镜操作医生，短透明帽结肠镜能缩短到达回盲部时间，有利于通过回盲瓣，该技术适合临床推广。

Objective This prospective randomized controlled trial was to assess efficacy of the cap-fitted colonoscopy （CFC）. Methods A total of 160 patients who underwent colonoscopic examinations at Digestive Endoscopy Center of Drum Tower Hospital met the criteria and were randomized to CFC group （n = 80） and regular control group （n = 80 ）. All colonoscopies were performed by two middle-level endoscopists without anesthesia. BMI, surgery history, starting time, time to access the cecum, ending time, bowel preparation, conclusions, attempts to pass the ileocecal valves, and patient discomfort were recorded after the examinations. Results Among 80 patients in the CFC group, the cecum was not intubated in 7 patients due to narrow bowel with the mean cecal intubation time being 7.5 ± 4. 0 minutes. Cecum intubation was not achieved in 4 of the 80 patients in the control group with the mean cecal intubation time being 9. 8 ± 4. 5 minutes. There was significant difference in the mean cecal intubation time （P =0. 011）. The terminal ileum was not accessed in 3 patients in the CFC group. The average attempts for passing the ileocecal valves were 1.32 for the rest of 70 patients. The terminal ileum was not accessed in 8 patients in the control group. The average attempts for passing the ileocecal valves were 1.96 for the rest of 68 patients （P = 0. 001 compared with CFC group）. There was no significant difference in polyp detection rate between the CFC group （32. 88%, 24/73） and the control group （28.95%, 27/76, P 〉 0.05）. Conclusion For middlelevel colonoscopists, CFC shortens cecal intubation time, facilitates passing the ileocecal valves, and improves polyp detection rate. This technique is promising for wider use in clinic.