软结肠镜诊治下消化道外科疾病可靠性探讨

Application of colonoscopy in diagnosis and treatment of surgical diseases of lower gastrointestinal tract

目的 探讨应用软结肠镜 (内镜 )对常见下消化道外科疾病的诊治 ,以提高利用内镜进行诊治的安全性及疗效。方法 回顾 1984～ 2 0 0 1年 3 793 9例行内镜诊治的病人 ,其中行内镜治疗 90 3 9例 ,包括低位肠梗阻 64例、乙状结肠扭转 11例、假性结肠梗阻 6例、下消化道出血 56例、良性肠狭窄 2 3例及肠道息肉 8879例。总结操作体会 ,分析疗效及并发症的原因。结果 低位肠梗阻明确梗阻原因、部位者 3 5例 (54 7% ,3 5/ 64) ;乙状结肠扭转复位成功 11例 (10 0 % ,11/ 11) ;假性结肠梗阻经内镜减压 ,治愈者 5例 (83 3 % ,5/ 6) ,急性下消化道出血明确出血原因及部位者 3 7例 (66 1% ,3 7/ 56) ,3 7例中立即经内镜止血成功者 3 6例 (97 3 % ,3 6/ 3 7) ;结、直肠吻合口经内镜下扩张均成功 (10 0 % ,2 3 / 2 3 ) ;内镜下行大肠息肉摘除术 8864例 ,共 10 10 5枚 ,术后出血 4例 ,迟发性穿孔2例 ;术中经内镜行小肠息肉摘除术 15例 ,共 412枚 ,术后无并发症。结论 内镜提高了下消化道外科疾病的诊治水平 。

Objective To discuss the use of colonoscopy in surgical disease of lowe r gastro intestinal tract and improve colonoscopic safety and efficiency in diagnosis and treatment. Methods From 1984 to 2001, thirty- seven thousand an d nine hundred t hirty- nine cases were diagnosed and treated by colonoscopy in our department. Am ong them, nine- thousand and thirty-nine cases, including 64 cases of lower ileu s, 11 cases of sigmoid volvulus, 6 cases of colonic pseudo- obstruction, 56 cases of acute lower gastrointestinal tract bleeding, 23 cases of benign anastomatic stricture and 8879 cases of intestinal polyp, were treated by colonoscopy. Resul ts Causes and sites of lower ileus in 35 cases (54.7%,35/64) were ascer tained; sigmoid volvulus in 11 cases (100%,11/11) was replaced; colonic pseudo- obstructi on in 5 cases (83.3%,5/6) was healed by colonoscopic decompression; causes and s ites of acute lower gastrointestinal tract bleeding in 37 cases (66.1%,37/56) we re ascertained, and in the meantime bleeding was stopped in 36 cases (97.3%,36/3 7); anastomatic stricture in 23 cases(100%,23/23) was dilated; colonoscopic poly pectomy was performed in 8864 cases of colorectal polyp (total 10105 polyps), p ostoperative bleeding in 4 cases and delayed colonic perforation in 2 cases occu rred; during Laparotomy colonoscopic polypectomy was performed in 15 cases of sm all intestinal polyp ( total 415 polyps ),without complication. Conclusi on Colo noscopy improves diagnostic and therapeutic level in disease of lower gastrointe stinal tract ,but doctors must grasp applying indication.