水交换法在老年患者结肠镜检查中的应用研究

Application of Water Exchange Method for Colonoscopy in the Elderly

目的探讨水交换法在老年患者结肠镜检查中的临床应用前景。方法选择2018年6月-12月在华东医院消化内镜中心行结肠镜筛查的老年患者(年龄≥65岁)200例,随机分配至水交换法组和注气法组,每组100例。收集并比较2组的性别、年龄、体重指数(body mass index, BMI)、腹部手术史及便秘史等患者一般资料。在结肠镜术中及术后记录2组患者腹痛最大评分、肠道准备情况、进镜时间、退镜时间、盲肠到达率,息肉检出率(Polyp detection rate, PDR)、腺瘤检出率(Adenoma detection rate, ADR)以及再检意愿,并统计比较2组各项指标的差异。结果 2组的性别、年龄、BMI、腹部手术史和便秘情况差异均无统计学意义(P>0.05)。水交换法组肠道准备评分明显高于注气法组[(7.84±0.95)分vs (7.34±0.92)分,P<0.01]。水交换法组最大疼痛评分明显低于注气法组[(1.7±1.7)分vs(2.8±2.2)分,P<0.01]。水交换法组进镜时间明显多于注气法组[(371.9±102.5)s vs (251.6±66.4)s,P<0.01];水交换法组PDR明显高于注气法组(38%vs 24%,P<0.05)、水交换法组ADR明显高于注气法组(31%vs 19%,P<0.05);水交换法组再检意愿显著高于注气法组(90%vs 62%,P<0.01)。2组盲肠到达率相近,差异无统计学意义(99%vs100%,P>0.05)。结论水交换法进镜时间虽长于注气法,但水交换法可显著减少老年患者结肠镜检查中的疼痛,并提高息肉检出率、腺瘤检出率及患者再检意愿。

Objective To discuss the clinical application of water exchange (WE) method for colonoscopy in the elderly.Methods 200 elderly (aged ≥65 y) in out-patient clinic of Huadong Hospital undergoing non-anesthetic screening colonoscopy were randomly divided into 2 groups: WE group and AI (air insufflation) group;the general information of the cases in both groups including gender,age,body mass index (BMI),history of abdominal surgery and history of constipation were collected;the maximum score of abdominal pain,bowel preparation,insertion and withdrawing time, cecumarrival rate,polyp detection rate (PDR),adenoma detection rate (ADR) and willingness to repeat colonoscopy were recorded during and after colonoscopy;the differences in these factors between the 2 groups were analyzed statistically.Results There existed no significant statistical differences in gender,age,body mass index (BMI),history of abdominal surgery and history of constipation between the 2 groups (P>0.05);the bowel preparation score in WE group was higher than that in AI group with a significant difference [(7.84±0.95)vs (7.34±0.92),P<0.01] while the maximum pain score in WE group was lower than that in AI group with significant difference [(1.7±1.7) vs(2.8±2.2),P<0.01];the insertion time in WE group was longer than that in AI group with significant difference [(371.9±102.5) s vs(251.6±66.4) s,P<0.01];PDR in WE group were higher than that in AI group with significant difference (38%vs 24%,P<0.05);ADR in WE group was higher than that in AI group with significant difference (31%vs19%,P<0.05);willingness to repeat colonoscopy in WE group was higher than that in AI group with significant difference (90% vs 62%,P<0.01);cecum arrival rate in both group showed no obvious statistical difference (99%vs100%,P>0.05).Conclusions Water exchange method for colonoscopy in the elderly can effectively reduce the pain,raise the PDR and ADR,and lead the elderly to have a high willingness to repeat colonoscopy.