水交换结肠镜的临床应用价值

Clinical value of water exchange colonoscopy

目的探讨水交换法相较于普通结肠镜患者的麻醉恢复时间、回盲部到达率和腺瘤检出率等方面的应用价值。方法200例初诊患者随机平均分为水交换组和普通组各100例，予常规肠道准备和丙泊酚静脉麻醉；由两位熟练的内镜医师平均完成操作；术后分析比较两组患者的麻醉恢复时间、回盲部到达率和腺瘤检出率。结果水交换法和普通结肠镜患者的麻醉恢复时间分别为（8．08±0．58）min和（12．34±0．72）min（F=2147．33，P〈0．05）；回盲部到达率分别为100．00％和96．00％（χ^2=4．17，P〈0．05）；全结肠腺瘤检出率分别为43．00％（43／100）和29．00％（29／100）（χ^2=4．25，P〈0．05），其中直径〈1．0em腺瘤分别占83．96％（89／106）和70．59％（48／68）（χ^2=4．43，P〈0．05）；近端结肠腺瘤检出率分别为28．00％（28／100）和20．00％（20／100）（χ^2=1．75，P〉0．05），直径〈1．0cm腺瘤分别占90．41％（66／73）和74．47％（35／47）（χ^2=5．45，P〈0．05）。结论水交换法结肠镜可减少患者的麻醉恢复时间，同时增加回盲部到达率和腺瘤检出率。

Objective To compare sedated water exchange and conventional colonoscopy in the recovery time, rates of reaching ileocecal valve and adenoma detection. Methods A total of 200 newly diagnosed patients undergoing colonoscopy with routine bowel preparation and propofol intravenous anesthesia were randomly divided into 2 groups： water exchange group（WE） and conventional group, 100 patients in each group. The operations were performed by two experienced physicians. The recovery time, rates of reaching ileocecal valve and adenoma detection of each group were analyzed and compared after operation. Results The recovery times of patients in water exchange and conventional groups were 8.08±0. 58 min and 12. 34±0. 72 rain, respectively （F = 2 147. 33, P〈0. 05）. Rates of reaching ileocecal valve were 100. 00% （ 100/100, WE group） and 96. 00% （ 96/100, conventional group）, respectively（χ^2 = 4. 17, P〈0. 05 ）. Adenoma detection rates of whole colon were 43.00% （ 43/100, WE group） and 29.00% （ 29/100, conventional group） （X2 = 4. 25, P〈 0. 05 ）, of which small adenomas （ 〈 1.0 cm ） accounted for 83.96% （ 89/106, WE group） and 70. 59% （ 48/68, conventional group ） （χ^2 = 4.43, P〈 0. 05 ）, respectively. Adenoma detection rates of proximal colon were 28. 00% （28/100, WE group） and 20. 00% （20/100, conventional group） （χ^2 = 1.75,P〉 0.05 ） , of which small adenomas （ 〈 1.0 era） accounted for 90. 41% （ 66/73, WE group ） and 74.47% （ 35/47, conventional group ） （χ^2 = 5.45, P 〈 0. 05 ）, respectively. Conclusion Water exchange eolonoscopy can not only shorten the recovery time of patients, but also increase rates of reaching ileoeecal valve and adenoma detection.