透明帽结合胃镜取物术治疗消化道异物的疗效及其安全性
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摘要
目的探讨透明帽结合胃镜取物术治疗消化道异物的疗效及其安全性。方法选取2014年6月至2017年6月西安医学院第二附属医院收治的消化道异物患者100例,依据治疗方法分为透明帽组和常规组,每组50例,常规组给予胃镜取物术治疗,透明帽组在此基础上辅加透明帽。结果透明帽组和常规组胃镜入消化道时(T1)、取异物时(T2)的心率(HR)、平均动脉压(MAP)明显高于术前(T0),透明帽组T1、T2时刻的HR、MAP明显低于常规组,差异有统计学意义(P<0.05);透明帽组视野优良率、手术成功率明显高于常规组,透明帽组手术时间、并发症发生率明显低于常规组,差异有统计学意义(P<0.05)。结论透明帽结合胃镜取物术治疗可有效改善消化道异物患者术中应激反应和提高视野优良率,有利于提高患者的治疗效果,且安全性更好,值得临床进一步推广。
Objective To investigate the curative effect and safety of transparent cap combined with gastroscopy in treatment of the foreign body in gastrointestinal tract. Methods One hundred patients with the foreign body in gastrointestinal tract were selected from Jun. 2014 to Jun. 2017 in the Second Affiliated Hospital of Xi'an Medical University.According to the random distribution,all patients were divided into transparent cap group and normal group,50 cases in each group. Normal group was treated with gastroscopy,while transparent cap group on the basis was added transparent cap. Results The heart rate( HR) and mean arterial pressure( MAP) when gastroscope got into the digestive tract( T1) and took foreign objects( T2) in transparent cap group and normal group were significantly higher than those in the preoperative( T0),HR,MAP of T1 and T2 in transparent cap group were significantly lower than those in the normal group,the difference was statistically significant( P < 0. 05). The view excellence rate,success rate in the transparent cap group were significantly higher than those in the normal group,the operation time,complication rate in the transparent cap group were significantly lower than those in the normal group,the difference was statistically significant( P < 0. 05). Conclusion Transparent cap combined with gastroscopy treatment can effectively improve the stress response and the view excellence rate in patients with the foreign body in gastrointestinal tract,which is beneficial to improve the curative effect of patients,and it has better safety,it's worth for further clinical promotion.
Objective To investigate the curative effect and safety of transparent cap combined with gastroscopy in treatment of the foreign body in gastrointestinal tract. Methods One hundred patients with the foreign body in gastrointestinal tract were selected from Jun. 2014 to Jun. 2017 in the Second Affiliated Hospital of Xi'an Medical University.According to the random distribution,all patients were divided into transparent cap group and normal group,50 cases in each group. Normal group was treated with gastroscopy,while transparent cap group on the basis was added transparent cap. Results The heart rate( HR) and mean arterial pressure( MAP) when gastroscope got into the digestive tract( T1) and took foreign objects( T2) in transparent cap group and normal group were significantly higher than those in the preoperative( T0),HR,MAP of T1 and T2 in transparent cap group were significantly lower than those in the normal group,the difference was statistically significant( P < 0. 05). The view excellence rate,success rate in the transparent cap group were significantly higher than those in the normal group,the operation time,complication rate in the transparent cap group were significantly lower than those in the normal group,the difference was statistically significant( P < 0. 05). Conclusion Transparent cap combined with gastroscopy treatment can effectively improve the stress response and the view excellence rate in patients with the foreign body in gastrointestinal tract,which is beneficial to improve the curative effect of patients,and it has better safety,it's worth for further clinical promotion.
引文
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[6]何玉兰,钟强.不同方法取出上消化道异物对食管粘膜继发损伤的探讨[J].河南中医,2013,33(B10):173.HE Y L,ZHONG Q.Study on esophageal secondary injury of upper digestive tract foreign body removal in different methods[J].Henan Tradit Chin Med,2013,33(B10):173.
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[8]陈竹林,姜晓娜,李科.用无痛胃镜异物取出术治疗小儿胃内异物的效果研究[J].当代医药论丛,2015,13(13):249-250.CHEN Z L,JIANG X N,LI K.The effect of foreign body removal by painless gastroscopy in the treatment of foreign bodies in the stomach of children[J].Contemporary Medicine Forum,2015,13(13):249-250.
[9]SUGAWA C,ONO H,TALEB M,et al.Endoscopic management of foreign bodies in the upper gastrointestinal tract:a review[J].World J Gastrointest Endosc,2014,6(10):475-481.DOI:10.4253/wjge.v6.i10.475.
[10]吴家森,殷海,何引,等.插管全身麻醉下Hopkins内镜治疗小儿气管及支气管异物的临床研究[J].中国内镜杂志,2015,21(6):644-646.WU J S,YIN H,HE Y,et al.Removal of infant bronchial foreign bodies by Hopkins telescopy under general anesthesia with endotracheal intubation[J].China Journal of Endoscopy,2015,21(6):644-646.
[11]SAHN B,MAMULA P,FORD C A.Review of foreign body ingestion and esophageal food impaction management in adolescents[J].J Adolesc Health,2014,55(2):260-266.
[12]贺奇彬,任玮,郭慧敏,等.短透明帽结肠镜法在单人结肠镜中应用的前瞻性随机对照研究[J].中华消化内镜杂志,2015,32(12):804-807.DOI:10.3760/cma.j.issn.1007-5232.2015.12.006.HE Q B,REN W,GUO H M,et al.The efficacy of a short transparent hood attached to the tip of the colonoscope:a single-center,randomized,controlled study[J].Chin J Dig Endosc,2015,32(12):804-807.DOI:10.3760/cma.j.issn.1007-5232.2015.12.006.
[13]MORGAN J L,THOMAS K,BRANNGART S,et al.Transparent cap colonoscopy versus standard colonoscopy:a systematic review and meta-analysis[J].Tech Coloproctol,2013,17(4):353-360.DOI:10.1007/s10151-013-0974-2.
[14]张坤峰,王妮娜,甘艳君,等.内镜下透明帽辅助处理食管上段异物的前瞻性研究[J].吉林医学,2014,35(5):1034-1035.ZHANG K F,WANG N N,GAN Y J,et al.A prospective study of endoscopic transparent cap for the treatment of upper esophageal foreign bodies[J].Jilin Med J,2014,35(5):1034-1035.
[15]CONIO M,FISHER D A,BLANCHI S,et al.Ons-step cirumferential endoscopic mucosal cap resection of Barrett’s esophagus with early neoplasia[J].Clin Res Hepatol Gastroenterol,2014,38(1):81-91.DOI:10.1016/j.clinre.2013.05.015.
[16]黄燕霞,霍桂莲,梁顺萍.内镜头端置透明帽辅助食管锐利异物取出术的探讨[J].医学理论与实践,2015,28(21):3006-3007.DOI:10.19381/j.issn.1001-7585.2015.21.083.HUANG Y X,HUO G L,LIANG S P.Discussion on the removal of sharp foreign body in esophagus with transparent cap inside the lens[J].The Journal of Medical Theory and Practice,2015,28(21):3006-3007.DOI:10.19381/j.issn.1001-7585.2015.21.083.
[17]ZHANG S,WANG J,WANG J.Transparent cap-assisted endoscopic management of foreing body in the upper esophagus:a randomized,controlled trial[J].J Gastroenterol Hepatol,2013,28(8):1339-1342.DOI:10.1111/jgh.12215.
[18]杨根源,郭晓红,龚飞跃,等.内镜头端透明帽辅助食管上段异物治疗的对照研究[J].胃肠病学和肝病学杂志,2013,22(7):645-647.DOI:10.3969/j.isson.1006-5709.2013.07.011.YANG G Y,GUO X H,GONG F Y,et al.A control study of the upper esophageal foreign bodies removal with endoscopic caps[J].Chin J Gastroenter Hepatol,2013,22(7):645-647.DOI:10.3969/j.isson.1006-5709.2013.07.011.
[19]刘文仕,吉建霞,蔡玲,等.透明帽辅助内镜治疗上消化道复杂异物36例分析[J].医学理论与实践,2015,28(23):3211-3212.DOI:10.19381/j.issn.1001-7585.2015.23.022.LIU W S,JI J X,CAI L,et al.Analysis of 36 cases of complex foreign bodies in upper digestive tract with transparent cap and auxiliary endoscope[J].The Journal of Medical Theory and Practice,2015,28(23):3211-3212.DOI:10.19381/j.issn.1001-7585.2015.23.022.
[20]LEE J S,CHUN H J,LEE J M,et al.Salvage technique for endoscopic removal of a sharp fish bone impacted in the esophagus using a transparent cap and detachable snares[J].Korean J Gastroenterol,2013,61(4):215-218.
[2]AKRAM J,AMIN F M,TOFT J G,et al.Treatment of foreign body impactions in oesophagus[J].Ugeskr Laeger,2013,175(10):640-643.
[3]李蕾蕾.前置透明帽对单人结肠镜检查进镜时间及息肉发现率的影响[J].航空航天医学杂志,2015,26(11):1330-1331.DOI:10.3969/j.issn.2095-1434.2015.11.009.LI LL.Effect of previa transparent cap on operation time and detection rate of polyp in single colonoscopy[J].Aerospace Medicine,2015,26(11):1330-1331.DOI:10.3969/j.issn.2095-1434.2015.11.009.
[4]孔庆印,曾宪忠,李兆申.美国消化道异物处理指南[J].中华消化内镜杂志,2004,21(1):69-70.DOI:10.3760/cma.j.issn.1007-5232.2004.01.039.KONG Q Y,ZENG X Z,LI Z S.Guide to the treatment of foreign body in the United States digestive tract[J].Chinese Journal of Digestive Endoscopy,2004,21(1):69-70.DOI:10.3760/cma.j.issn.1007-5232.2004.01.039.
[5]文政伟,雷平光,晏洁影,等.透明帽辅助胃镜异物取出术在食管入口异物取出的应用[J].中国临床研究,2015,28(6):764-766.DOI:10.13429/j.cnki.cjcr.2015.06.025.WEN Z W,LEI P G,YAN J Y,et al.Application of transparent cap to remove foreign body in gastroscope for removal of foreign body at esophageal inlet[J].Chin J Clin Res,2015,28(6):764-766.DOI:10.13429/j.cnki.cjcr.2015.06.025.
[6]何玉兰,钟强.不同方法取出上消化道异物对食管粘膜继发损伤的探讨[J].河南中医,2013,33(B10):173.HE Y L,ZHONG Q.Study on esophageal secondary injury of upper digestive tract foreign body removal in different methods[J].Henan Tradit Chin Med,2013,33(B10):173.
[7]WILLIAMS P,JAMESON S,BISHOP P,et al.Esophageal foreign bodies and eosinophilic esophagitis--the need for esophageal mucosal biopsy:a 12-year survey across pediatric subspecialties[J].Surg Endosc,2013,27(6):2216-2220.DOI:10.1007/s00464-012-2742-1.
[8]陈竹林,姜晓娜,李科.用无痛胃镜异物取出术治疗小儿胃内异物的效果研究[J].当代医药论丛,2015,13(13):249-250.CHEN Z L,JIANG X N,LI K.The effect of foreign body removal by painless gastroscopy in the treatment of foreign bodies in the stomach of children[J].Contemporary Medicine Forum,2015,13(13):249-250.
[9]SUGAWA C,ONO H,TALEB M,et al.Endoscopic management of foreign bodies in the upper gastrointestinal tract:a review[J].World J Gastrointest Endosc,2014,6(10):475-481.DOI:10.4253/wjge.v6.i10.475.
[10]吴家森,殷海,何引,等.插管全身麻醉下Hopkins内镜治疗小儿气管及支气管异物的临床研究[J].中国内镜杂志,2015,21(6):644-646.WU J S,YIN H,HE Y,et al.Removal of infant bronchial foreign bodies by Hopkins telescopy under general anesthesia with endotracheal intubation[J].China Journal of Endoscopy,2015,21(6):644-646.
[11]SAHN B,MAMULA P,FORD C A.Review of foreign body ingestion and esophageal food impaction management in adolescents[J].J Adolesc Health,2014,55(2):260-266.
[12]贺奇彬,任玮,郭慧敏,等.短透明帽结肠镜法在单人结肠镜中应用的前瞻性随机对照研究[J].中华消化内镜杂志,2015,32(12):804-807.DOI:10.3760/cma.j.issn.1007-5232.2015.12.006.HE Q B,REN W,GUO H M,et al.The efficacy of a short transparent hood attached to the tip of the colonoscope:a single-center,randomized,controlled study[J].Chin J Dig Endosc,2015,32(12):804-807.DOI:10.3760/cma.j.issn.1007-5232.2015.12.006.
[13]MORGAN J L,THOMAS K,BRANNGART S,et al.Transparent cap colonoscopy versus standard colonoscopy:a systematic review and meta-analysis[J].Tech Coloproctol,2013,17(4):353-360.DOI:10.1007/s10151-013-0974-2.
[14]张坤峰,王妮娜,甘艳君,等.内镜下透明帽辅助处理食管上段异物的前瞻性研究[J].吉林医学,2014,35(5):1034-1035.ZHANG K F,WANG N N,GAN Y J,et al.A prospective study of endoscopic transparent cap for the treatment of upper esophageal foreign bodies[J].Jilin Med J,2014,35(5):1034-1035.
[15]CONIO M,FISHER D A,BLANCHI S,et al.Ons-step cirumferential endoscopic mucosal cap resection of Barrett’s esophagus with early neoplasia[J].Clin Res Hepatol Gastroenterol,2014,38(1):81-91.DOI:10.1016/j.clinre.2013.05.015.
[16]黄燕霞,霍桂莲,梁顺萍.内镜头端置透明帽辅助食管锐利异物取出术的探讨[J].医学理论与实践,2015,28(21):3006-3007.DOI:10.19381/j.issn.1001-7585.2015.21.083.HUANG Y X,HUO G L,LIANG S P.Discussion on the removal of sharp foreign body in esophagus with transparent cap inside the lens[J].The Journal of Medical Theory and Practice,2015,28(21):3006-3007.DOI:10.19381/j.issn.1001-7585.2015.21.083.
[17]ZHANG S,WANG J,WANG J.Transparent cap-assisted endoscopic management of foreing body in the upper esophagus:a randomized,controlled trial[J].J Gastroenterol Hepatol,2013,28(8):1339-1342.DOI:10.1111/jgh.12215.
[18]杨根源,郭晓红,龚飞跃,等.内镜头端透明帽辅助食管上段异物治疗的对照研究[J].胃肠病学和肝病学杂志,2013,22(7):645-647.DOI:10.3969/j.isson.1006-5709.2013.07.011.YANG G Y,GUO X H,GONG F Y,et al.A control study of the upper esophageal foreign bodies removal with endoscopic caps[J].Chin J Gastroenter Hepatol,2013,22(7):645-647.DOI:10.3969/j.isson.1006-5709.2013.07.011.
[19]刘文仕,吉建霞,蔡玲,等.透明帽辅助内镜治疗上消化道复杂异物36例分析[J].医学理论与实践,2015,28(23):3211-3212.DOI:10.19381/j.issn.1001-7585.2015.23.022.LIU W S,JI J X,CAI L,et al.Analysis of 36 cases of complex foreign bodies in upper digestive tract with transparent cap and auxiliary endoscope[J].The Journal of Medical Theory and Practice,2015,28(23):3211-3212.DOI:10.19381/j.issn.1001-7585.2015.23.022.
[20]LEE J S,CHUN H J,LEE J M,et al.Salvage technique for endoscopic removal of a sharp fish bone impacted in the esophagus using a transparent cap and detachable snares[J].Korean J Gastroenterol,2013,61(4):215-218.