透明帽辅助结肠镜检查方法在结肠镜教学中的作用

The role of transparent cap-assisted colonoscopy in clinical training

目的 探讨透明帽辅助结肠镜检查方法在结肠镜教学中的作用。方法 选择2015年1月至2017年1月首都医科大学附属北京安贞医院消化内科第一次行非麻醉结肠镜检查的患者436例。根据既往是否有长期便秘或腹部手术病史，将患者分为普通患者262例和困难患者174例。根据随机数字表法，将普通患者分为标准法组123例与透明帽辅助法组139例；将困难患者分为标准法组81例与透明帽辅助法组93例。标准法组行结肠镜检查单人操作法，透明帽辅助法组行内镜前端附透明帽辅助结肠镜检查单人操作法。记录并比较患者一般临床资料和结肠镜检查结果。结果 在2组普通患者中，透明帽辅助法组达盲时间短于标准法组［（12±7）min比（14±9）min］，达盲率、结直肠息肉检出率高于标准法组［90.6%（126/139）比82.1%（101/139）、41.0%（57/139）比29.3%（36/123）］，患者最大疼痛程度评分低于标准法组［（5.9±2.3）分比（7.1±2.0）分］，差异均有统计学意义（均P＜0.05）。在2组困难患者中，透明帽辅助法组达盲时间短于标准法组［（11±5）min比（13±8）min］，患者最大疼痛程度评分低于标准法组［（5.7±2.3）分比（6.7±2.1）分］，差异均有统计学意义（均P＜0.05）。结论 透明帽辅助结肠镜检查方法在结肠镜教学中有重要作用，可以明显缩短内镜医师达盲时间，提高中等熟练内镜医师达盲率和结直肠息肉检出率，可以提高内镜医师培训水平。

Objective To investigate the role of transparent cap-assisted colonoscopy in clinical training of colonoscopy. Methods Totally 436 patients undergoing unsedated colonoscopy from January 2015 to January 2017 in Beijing Anzhen Hospital, Capital Medical University were enrolled; 262 ordinary patients were randomly divided into standard colonoscopy group（group A, 123 cases） and transparent cap-assisted colonoscopy group（group B, 139 cases）; 174 patients with histories of long-term constipation or abdominal surgery were randomly divided into standard colonoscopy group（group C, 81 cases） and transparent cap-assisted colonoscopy group（group D, 93 cases）. General clinical data and colonoscopy results were analyzed. Results The cecum-reaching time in group B was significantly shorter, cecum-reaching rate and the detection rate of colorectal polyps were significantly higher, and the maximum pain score was significantly lower than those in group A[（12±7）min vs （14±9）min, 90.6 %（126/139） vs 82.1%（101/139）, 41.0 %（57/139） vs 29.3%（36/123）, （5.9±2.3）points vs （7.1±2.0）points]（P〈0.05）. The cecum-reaching time in group D was significantly shorter and the maximum pain score was significantly lower than those in group C[（11±5）min vs （13±8）min, （5.7±2.3）points vs （6.7±2.1）points]（P〈0.05）. Conclusions Transparent cap-assisted colonoscopy can significantly shorten cecum-reaching time, increase cecum-reaching rate and the detection rate of colorectal polyps in clinical training of medium-skilled physicians.