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大肠憩室粪石嵌顿内镜下松解治疗的临床意义 被引量:2

Clinical value of endoscopic release therapy for fecal impaction in colorectal diverticulum
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摘要 目的评价大肠憩室粪石嵌顿内镜下松解治疗的临床意义。方法收集2018年1月—2020年9月汕头市中心医院内镜中心大肠镜检查发现的肠憩室粪石嵌顿并行内镜下松解治疗的患者作为观察组85例(后有2例因“急性阑尾炎”剔除出观察组),未处理患者作为对照组43例。以腹部症状缓解情况作为指标判断治疗是否有效。结果观察组83例大肠憩室伴粪石嵌顿患者,一次性松解成功的占42.2%(35/83),综合措施松解成功的占首次松解失败的25.0%(12/48),松解成功率为56.6%(47/83)。观察组未见与内镜治疗相关的并发症。观察组松解治疗后1周电话随访,成功松解的45例患者中阳性症状者33例,有效占90.9%(30/33),松解失败的38例患者中阳性症状者29例,有效占55.2%(16/29)。观察组总体的治疗有效率较对照组高[55.4%(46/83)比7.0%(3/43)],差异有统计学意义(χ2=23.354,P<0.01)。松解成功组、松解失败组、对照组比较,3组治疗有效率差异有统计学意义[65.2%(30/46)、29.7%(11/37)、7.0%(3/43),χ2=33.792,P<0.01];两两比较,松解成功组有效率最高,松解失败组有效率居中,对照组有效率最低,差异有统计学意义(P<0.017)。结论肠憩室粪石嵌顿内镜下松解治疗相对简单,能缓解和减少患者相关症状,避免并发症和漏诊误诊,疗效确切。肠镜诊疗过程中当发现肠憩室伴粪石嵌顿时使用一些方法对嵌顿的粪石进行松解有较大的实际意义。 Objective impaction in the colorectal diverticulum To evaluate the clinical value of endoscopic release therapy for fecal.Methods Data of patients with fecal impaction in the colorectal diverticulum who received endoscopy in Shantou Central Hospital from January 2018 to September 2020 were included in this study.Among them,85 patients treated with endoscopic release therapy were assigned to the observation group(2 patients were excluded from the observation group due to acute appendicitis),and 43 patients receiving no treatment were assigned to the control group.The relief of abdominal symptoms was used as an index to evaluate the clinical value of endoscopic release therapy for fecal impaction in the colorectal diverticulum.Results In the observation group,42.2%(35/83)were successfully released at one time.The successful comprehensive measures accounted for 25.0%(12/48)of the first release failure,and the total success rate was 56.6%(47/83).There were no complications related to endoscopy in the observation group.One week after the treatment,patients in the observation group were followed up by telephone.Among the 45 patients who were successfully released,positive symptoms of 30 patients disappeared or significantly improved with the effective rate of 90.9%(30/33).Among the 38 patients who failed to release the fecal impaction,19 had positive symptoms and 16 improved in varying degrees with the effective rate of 55.2%(16/29).The overall effective rate of the observation group was higher than that of the control group[55.4%(46/83)VS 7.0%(3/43)],showing significant difference(χ2=23.354,P<0.01).The effective rate were significant differences in the successful release group[65.2%(30/46)],unsuccessful release group[29.7%(11/37)]and the control group[7.0%(3/43),χ2=33.792,P<0.01].By pairwise comparison,the effective rate of the successful release group was the highest,followed by the unsuccessful release group,and that of the control group was the lowest with significant difference(P<0.017).Conclusion The endoscopic release therapy for fecal impaction in the colorectal diverticulum is relatively simple,which can relieve and reduce related symptoms,avoid complications,missed diagnosis and misdiagnosis,and show definite curative effects.When colorectal diverticulum with fecal impaction is found in the process of endoscopy,it is of great practical significance to release the incarcerated feces by means of different methods.
作者 黄耀奎 张洪实 林燕娟 黄逸纯 王小忠 Huang Yaokui;Zhang Hongshi;Lin Yanjuan;Huang Yichun;Wang Xiaozhong(Endoscopy Center,Shantou Central Hospital,Shantou 515031,China)
出处 《中华消化内镜杂志》 CSCD 2022年第9期731-734,共4页 Chinese Journal of Digestive Endoscopy
基金 汕头市医疗卫生科技计划项目(汕府科[2020]5号-78)。
关键词 憩室 结肠 粪便嵌塞 胃肠内窥镜 治疗 临床研究性 Diverticulum,colon Fecal impaction Endoscopes,gastrointestinal Therapies,investigational
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