二氧化碳结肠镜检查的动物实验和临床研究
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摘要
目的目前,结肠镜检查中注入空气在全世界绝大多数地方是使用的标准方法。然而,采用空气作为注入媒介的结肠镜检查存在一系列的并发症:检查后腹痛腹胀、空气栓塞、甚至爆炸等等。二氧化碳因其具有快速可吸收性、不可燃、不易形成气栓、易于代谢调节等特性,一种改良的使用二氧化碳作为注入媒介的结肠镜检查方法正现逐渐被临床接受。本研究的目的是制作一个简便的二氧化碳注气机,通过动物实验及临床随机对照试验评估二氧化碳结肠镜检查在临床应用中的有效性及安全性。
方法(1)采用二氧化碳减压器和流量计制作一个注气机,通过动物实验验证该设备注入二氧化碳在结肠镜应用中的有效性安全性,20条平均体重约12.5Kg的杂种犬随机分配到二氧化碳组和空气组进行结肠镜检查,评估检查前后的血气分析情况,通过腹平片检查对比其肠扩张情况。(2)收集本院门诊结肠镜检查的360例患者,随机分配到二氧化碳组(n=177)或空气组(n=183),采用自制的注气机操作。合并急性消化道出血或是严重心肺疾病的患者被排除在外。通过直观模拟评分(VAS)调查表分别于检查结束时及检查后1、3、6、24小时记录患者腹痛腹胀程度评分,以及腹胀的缓解时间;同时于结肠镜检查前、到达回盲部、回到直肠时、检查后四个时段记录患者呼气末二氧化碳分压。检查1小时后通过腹平片评估肠道气体残留情况。
结果(1)自制内镜二氧化碳注气设备输出气体压力为0.05Mpa,流量为2.8L/min,与结肠镜主机气泵注气效果相当。(2)动物实验中通过腹平片评估其肠扩张程度,比较在检查结束时(P＜0.01),检查后5分钟(P＜0.01),检查后30分钟(P＜0.01),检查后1小时(P＜0.01),二氧化碳组均明显优于空气组;而动脉血二氧化碳分压两组前后对比无明显差异,空气组前后对比(P=0.414),二氧化碳组前后(P=0.868)。(3)临床随机对照试验中一共353例患者完成调查,结果发现空气组在检查后1、3、6、24小时有腹痛的比例明显高于二氧化碳组(78%vs 10%,46%vs 2%,39%vs 0.5%,23%vs 0.5%,6%vs 0.5%,均P＜0.01);且检查后Air组有83%有不同程度腹胀,CO2组仅7%,P值＜0.01;腹胀缓解时间CO2组为0.82±0.51小时,而Air组为3.89±5.96小时,P值＜0.01;呼气末二氧化碳分压两组前后对比无明显差异,空气组前后对比(P=0.881),二氧化碳组前后(P=0.289)。患者检查后腹平片检查肠道气体残留二氧化碳组明显少于空气组,空气组有93%有明显肠扩张,而二氧化碳组为34%(P＜0.01)。
结论(1)自制二氧化碳注气机应用安全可靠,能够达到结肠镜主机气泵相同效果,在缺少专用内镜二氧化碳注气机的情况下,可望成为其的替代产品。(2)二氧化碳是一种有效而且安全的结肠镜注入气体媒介,在减少结肠镜检查后患者的腹痛腹胀方面明显优于空气,且对患者血PCO2值无明显影响。
Aims At present,air insufflation in colonoscopy has remained the standard method in most centres around the world.However,there is a series of complication in conventional colonoscopy in which air is used as an insufflating agent,such as abdominal pain or bloating after colonoscopy,air embolism,even explosion et al.Recently,a modified technique of colonoscopy using carbon dioxide(CO2)as an insufflating agent has gained gradually clinical acceptance,because CO2 have some good feature,such as high absorbability,non-conbustible,difficult to form gas embolism,easy to regulate metabolism.The objective of this study were to make a simple carbon dioxide insufflator,to evaluate CO2 insufflation in colonoscopy performance and safety for animal experiment and a randomized controlled clinical trial.
Methods(1)The insufflator is made of a CO2 regulator and a flow instrument.The performance and safety of CO2 insufflation in colonoscopy have been evaluated with animal experiment.Twenty hybrid dogs with an average weight of 12.5 kg were randomized to CO2 group or to air group for colonoscopy.To evluate the situation before and after the blood gas analysis,and contrast bowel distention by abdominal plain film examination.(2)Three hundred sixty patients collected from our hospital were randomized to undergo colonoscopy with insufflation of air (n=183)or CO2(n=177)by means of a the new homemade regulator. Patients with active GI bleeding and severe cardiopulmonary disease were excluded.Abdominal pain or bloating scores were recorded immediately after colonoscopy and at 1,3,6 and 24 hours by VAS,and Abdominal distention mitigation time.Meanwhile,ETCO2 were observed in four period:before exam,arrived caecum,back rectum,after exam.Residual colonic gas was evaluated on abdominal radiographs at 1hours.
Results(1)The output gas pressure of homemade endoscopic CO2 regulator can reached 0.05Mpa,the flow 2.8L/min,the effect of insufflation were equal to new insufflator with air pump in endoscopic master station.(2)To assess the degree of bowl distention was slightly in the CO2 group compared with the air group at 0 minute(P＜0.01),at 5 minutes(P＜0.01),at 30 minutes(P＜0.01),at 1 hours(P＜0.01)after the procedure.There were no differences in P CO2 values in artery between the two groups before and after procedure,at the air group (P=0.414),at the CO2 group(P=0.868).(3)Three hundred fifty three patients completed the randomized controlled clinical trial. Postprocedural pain at 1,3,6 and 24 hours were significantly less in the CO2 group.93%of patients insufflated with air had colonic severe distension versus 34%for those in the CO2 group(P＜0.01).The rate of patients insufflated with air had pain at,respectively,the end,1 hours,3hours,6 hours and 24 hours(78%vs 10%,46%vs 2%,39%vs 0.5%,23%vs 0.5%,6%vs 0.5%,respectively P＜0.01)higher than the CO2 group.Abdominal distention scores in VAS were indicate that 83% patients have Varying degrees in Air group,but only 7%in CO2 group, P＜0.01.The distention mitigation time in CO2 group was Significantly less than Air group(0.82±0.51 vs 3.89±5.96hours,P＜0.01).There were no differences in ETCO2 values between the two groups before and after procedure,at the air group(P=0.881),at the CO2 group(P=0.289). Residual colonic gas in CO2 group was less than Air group by abdominal plain film examination(34%vs 93%,P＜0.01).
Conclusions(1)The homemade CO2 regulator was safe and reliable,can achieved the same effect for colonoscopy gas pump,is ecpected to become a substitute product as the absence of dedicated endoscopic carbon dioxide regulator.(2)CO2 is an effective and safe gas media insufflate colonoscopy,is superior to the Air in the aspects for reducing the abdominal pain and distention after colonoscopy,and no significant impact on the arterial blood PCO2 value in the patients after colonoscopy.
方法(1)采用二氧化碳减压器和流量计制作一个注气机,通过动物实验验证该设备注入二氧化碳在结肠镜应用中的有效性安全性,20条平均体重约12.5Kg的杂种犬随机分配到二氧化碳组和空气组进行结肠镜检查,评估检查前后的血气分析情况,通过腹平片检查对比其肠扩张情况。(2)收集本院门诊结肠镜检查的360例患者,随机分配到二氧化碳组(n=177)或空气组(n=183),采用自制的注气机操作。合并急性消化道出血或是严重心肺疾病的患者被排除在外。通过直观模拟评分(VAS)调查表分别于检查结束时及检查后1、3、6、24小时记录患者腹痛腹胀程度评分,以及腹胀的缓解时间;同时于结肠镜检查前、到达回盲部、回到直肠时、检查后四个时段记录患者呼气末二氧化碳分压。检查1小时后通过腹平片评估肠道气体残留情况。
结果(1)自制内镜二氧化碳注气设备输出气体压力为0.05Mpa,流量为2.8L/min,与结肠镜主机气泵注气效果相当。(2)动物实验中通过腹平片评估其肠扩张程度,比较在检查结束时(P＜0.01),检查后5分钟(P＜0.01),检查后30分钟(P＜0.01),检查后1小时(P＜0.01),二氧化碳组均明显优于空气组;而动脉血二氧化碳分压两组前后对比无明显差异,空气组前后对比(P=0.414),二氧化碳组前后(P=0.868)。(3)临床随机对照试验中一共353例患者完成调查,结果发现空气组在检查后1、3、6、24小时有腹痛的比例明显高于二氧化碳组(78%vs 10%,46%vs 2%,39%vs 0.5%,23%vs 0.5%,6%vs 0.5%,均P＜0.01);且检查后Air组有83%有不同程度腹胀,CO2组仅7%,P值＜0.01;腹胀缓解时间CO2组为0.82±0.51小时,而Air组为3.89±5.96小时,P值＜0.01;呼气末二氧化碳分压两组前后对比无明显差异,空气组前后对比(P=0.881),二氧化碳组前后(P=0.289)。患者检查后腹平片检查肠道气体残留二氧化碳组明显少于空气组,空气组有93%有明显肠扩张,而二氧化碳组为34%(P＜0.01)。
结论(1)自制二氧化碳注气机应用安全可靠,能够达到结肠镜主机气泵相同效果,在缺少专用内镜二氧化碳注气机的情况下,可望成为其的替代产品。(2)二氧化碳是一种有效而且安全的结肠镜注入气体媒介,在减少结肠镜检查后患者的腹痛腹胀方面明显优于空气,且对患者血PCO2值无明显影响。
Aims At present,air insufflation in colonoscopy has remained the standard method in most centres around the world.However,there is a series of complication in conventional colonoscopy in which air is used as an insufflating agent,such as abdominal pain or bloating after colonoscopy,air embolism,even explosion et al.Recently,a modified technique of colonoscopy using carbon dioxide(CO2)as an insufflating agent has gained gradually clinical acceptance,because CO2 have some good feature,such as high absorbability,non-conbustible,difficult to form gas embolism,easy to regulate metabolism.The objective of this study were to make a simple carbon dioxide insufflator,to evaluate CO2 insufflation in colonoscopy performance and safety for animal experiment and a randomized controlled clinical trial.
Methods(1)The insufflator is made of a CO2 regulator and a flow instrument.The performance and safety of CO2 insufflation in colonoscopy have been evaluated with animal experiment.Twenty hybrid dogs with an average weight of 12.5 kg were randomized to CO2 group or to air group for colonoscopy.To evluate the situation before and after the blood gas analysis,and contrast bowel distention by abdominal plain film examination.(2)Three hundred sixty patients collected from our hospital were randomized to undergo colonoscopy with insufflation of air (n=183)or CO2(n=177)by means of a the new homemade regulator. Patients with active GI bleeding and severe cardiopulmonary disease were excluded.Abdominal pain or bloating scores were recorded immediately after colonoscopy and at 1,3,6 and 24 hours by VAS,and Abdominal distention mitigation time.Meanwhile,ETCO2 were observed in four period:before exam,arrived caecum,back rectum,after exam.Residual colonic gas was evaluated on abdominal radiographs at 1hours.
Results(1)The output gas pressure of homemade endoscopic CO2 regulator can reached 0.05Mpa,the flow 2.8L/min,the effect of insufflation were equal to new insufflator with air pump in endoscopic master station.(2)To assess the degree of bowl distention was slightly in the CO2 group compared with the air group at 0 minute(P＜0.01),at 5 minutes(P＜0.01),at 30 minutes(P＜0.01),at 1 hours(P＜0.01)after the procedure.There were no differences in P CO2 values in artery between the two groups before and after procedure,at the air group (P=0.414),at the CO2 group(P=0.868).(3)Three hundred fifty three patients completed the randomized controlled clinical trial. Postprocedural pain at 1,3,6 and 24 hours were significantly less in the CO2 group.93%of patients insufflated with air had colonic severe distension versus 34%for those in the CO2 group(P＜0.01).The rate of patients insufflated with air had pain at,respectively,the end,1 hours,3hours,6 hours and 24 hours(78%vs 10%,46%vs 2%,39%vs 0.5%,23%vs 0.5%,6%vs 0.5%,respectively P＜0.01)higher than the CO2 group.Abdominal distention scores in VAS were indicate that 83% patients have Varying degrees in Air group,but only 7%in CO2 group, P＜0.01.The distention mitigation time in CO2 group was Significantly less than Air group(0.82±0.51 vs 3.89±5.96hours,P＜0.01).There were no differences in ETCO2 values between the two groups before and after procedure,at the air group(P=0.881),at the CO2 group(P=0.289). Residual colonic gas in CO2 group was less than Air group by abdominal plain film examination(34%vs 93%,P＜0.01).
Conclusions(1)The homemade CO2 regulator was safe and reliable,can achieved the same effect for colonoscopy gas pump,is ecpected to become a substitute product as the absence of dedicated endoscopic carbon dioxide regulator.(2)CO2 is an effective and safe gas media insufflate colonoscopy,is superior to the Air in the aspects for reducing the abdominal pain and distention after colonoscopy,and no significant impact on the arterial blood PCO2 value in the patients after colonoscopy.
引文
[1] Wolff WI. Colonoscopy: history and development. Am J Gastroenterol, 1989 Sep; 84(9): 1017-25.
[2] Cappell MS, Friedel D, et al. The role of sigmoidoscopy and colonoscopy in the diagnosis and management of lower gastrointestinal disorders: endoscopic findings, therapy, and complications. Med Clin North Am, 2002 Nov; 86(6): 1253-1288.
[3] Huang EH, Marks JM, et al. The diagnostic and therapeutic roles of colonoscopy: a review. Surg Endosc,2001 Oct; 15: 1373-1380.
[4] Zmora O, Dinnewitzer AJ, Pikarsky AJ, et al. Intraoperative endoscopy in laparoscopic colectomy. Surg Endosc, 2002 Feb; 16: 808-811.
[5] Church J, Delaney C, et al. Randomized, controlled trial of carbon dioxide insufflation during colonoscopy. Dis Colon Rectum, 2003; 46: 322-326.
[6] Bretthauer M, Thiis-Evensen E, Huppertz-Hauss G, et al. NORCCAP (Norwegian Colorectal Cancer Prevention): a randomised trial to assess the safety and efficacy of carbon dioxide versus air insufflation in colonoscopy. Gut, 2002; 50: 604-607.
[7] Stevenson GW, Wilson JA, Wilkinson J, et al. Pain following colonoscopy: elimination with carbon dioxide. Gastrointest Endosc, 1992; 38: 564-567.
[8] Sumanac K, Zealley I, Fox BM, et al. Minimizing postcolonoscopy abdominal pain by using CO(2) insufflation: a prospective, randomized, double blind, controlled trial evaluating a new commercially available CO(2) delivery system. Gastrointest Endosc, 2002; 56: 190-194.
[9] Katzgraber F, Glenewinkel F, Fischler S, et al. Mechanism of fatal air embolism after gastrointestinal endoscopy. Int J Legal Med, 1998; 111: 154-156.
[10] Arhan P, Bouchoucha M, Martelli H, et al. Relationship between parietal blood flow studies in the left colon and the rectum in dogs. Colonic pressure and blood flow. Dis Colon Rectum, 1988; 31: 54-57
[11] Yasumasa K, Nakajima K, Endo S, et al. Carbon dioxide insufflation attenuates parietal blood flow obstruction in distended colon. Surg Endosc, 2006 Apr;20(4):587-94.
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[1] Wolff WI. Colonoscopy: history and development. Am J Gastroenterol, 1989,84(9): 1017-25.
[2] Cappell MS, Friedel D. The role of sigmoidoscopy and colonoscopy in the diagnosis and management of lower gastrointestinal disorders: endoscopic findings, therapy, and complications. Med Clin North Am, 2002, 86(6):1253-1288.
[3] Huang EH, Marks JM. The diagnostic and therapeutic roles of colonoscopy: a review. Surg Endosc, 2001, 15: 1373-1380.
[4] Waye JD. Colonoscopy. CA Cancer J Clin, 1992,42: 350-365.
[5] Zmora O, Dinnewitzer AJ, Pikarsky AJ, et al. Intraoperative endoscopy in laparoscopic colectomy. Surg Endosc, 2002,16: 808-811.
[6] Church J, Delaney C. Randomized, controlled trial of carbon dioxide insufflation during colonoscopy. Dis Colon Rectum, 2003,46: 322-326.
[7] Bretthauer M, Thiis-Evensen E, Huppertz-Hauss G, et al. NORCCAP (Norwegian Colorectal Cancer Prevention): a randomised trial to assess the safety and efficacy of carbon dioxide versus air insufflation in colonoscopy. Gut, 2002, 50:604-607.
[8] Stevenson GW, Wilson JA, Wilkinson J, et al. Pain following colonoscopy: elimination with carbon dioxide. Gastrointest Endosc, 1992, 38: 564-567.
[9] Sumanac K, Zealley I, Fox BM, et al. Minimizing postcolonoscopy abdominal pain by using CO(2) insufflation: a prospective, randomized, double blind,controlled trial evaluating a new commercially available CO(2) delivery system. Gastrointest Endosc, 2002, 56: 190-194.
[10] Katzgraber F, Glenewinkel F, Fischler S, et al. Mechanism of fatal air embolism after gastrointestinal endoscopy. Int J Legal Med, 1998, 111: 154-156.
[11] Arhan P, Bouchoucha M, Martelli H, et al. Relationship between parietal blood flow studies in the left colon and the rectum in dogs. Colonic pressure and blood flow.Dis Colon Rectum,1988,31:54-57
[12]Boley SJ,Agrawal GP,Warren AR,et al.Pathophysiologic effects of bowel distention on intestinal blood flow.Am J Surg,1969,117:228-234.
[13]Yasumasa K,Nakajima K,Endo S,et al.Carbon dioxide insufflation attenuates parietal blood flow obstruction in distended colon.Surg Endosc,2006,20(4):587-94.
[14]Kim SH,Milsom JW,Church JM,et al.Perioperative tumor localization for laparoscopic colorectal surgery.Surg Endosc,1997,11:1013-1016.
[15]Carter HG.Explosion in the colon during electrodesiccation of polyps.Am J Surg,1952,11:514-16.
[16]Kim SH,Milsom JW,Church JM,et al.Perioperative tumor localization for laparoscopic colorectal surgery.Surg Endosc,1997,11:1013-1016.
[17]Ladas SD,Karamanolis G;Ben-Soussan E.Colonic gas explosion during therapeutic colonoscopy with electrocautery.World J Gastroenterol.2007,13(40):5295-8.
[18]Becker GL.Prevention of gas explosions in the large bowel duringelectrosurgery.Surg Gynecol Obstet,1953,97:463.
[19]曹月敏主编.腹腔镜外科学.石家庄:河北科技出版社,1999,192.
[20]Williams CB.Who's for CO2? Gastrointest Endosc,1986,32:365-7.
[21]Roberts MW,Mathiesen KA,Ho HS,et al.Cardiopulmonary responses to intravenous infusion of soluble and relatively insoluble gases.Surg Endosc,1997,11:341-346.
[22]Saltzman HA,Sieker HO,et al.Intestinal response to changing gaseous environments:normobaric and hyperbaric observations.Ann N Y Acad Sci,1968,150:31-39.
[23]Holthausen UH,Nagelschmidt M,Troidl H.CO(2)pneumoperitoneum:what we know and what we need to know.World J Surg,1999,23(8):794-800.
[24]Wolf JS Jr.Pathophysiologic effects of prolonged laparoscopicoperation.Semin Surg Oncol,1996,12:86-95.
[25]Nesek-Adam V,Mrsic V,Smiljanic A,et al.Pathophysiologic effects of CO2 pneumoperitoneum in laparoscopic surgery.Acta Med Croatica,2007,61(2):165-70.
[26]Southern DA,Mapleson WW.Which insuffiation gas for laparoscopy.BMJ.1993,27;307(6916):1424.
[27]丁晓曼,冷金花,郎景和.二氧化碳气腹对机体的影响.中华妇产科杂志,2001,36(3):185-186.
[28]Uen YH,Chen Y,Kuo CY,et al.Randomized trial of low-pressure carbon dioxide-elicited pneumoperitoneum versus abdominal wall lifting for laparoscopic cholecystectomy.J Chin Med Assoc,2007,70(8):324-30.
[29]Scullion DA,Wetton CW,Davies C,et al.The use of air or CO2 as insuffiation agents for double contrast barium enema(DCBE):is there a qualitative difference? Clin Radiol,1995,50(8):558-61.
[30]Robson NK,Lloyd M,Regan F.The use of carbon dioxide as an insuffiation agent in barium enema-does it have a role? Br J Radiol,1993,66(783):197-8.
[31]Gellett LR,Farrow R,Bloor C,et al.Pain after small bowel meal and pneumocolon:a randomized controlled trial of carbon dioxide versus air insuffiation.Clin Radiol,1999,54(6):381-3.
[32]Hawkins IF.Carbon dioxide digital subtraction angiography.AJR Am J Roentgenol,1982,139(1):19-24.
[33]卢伟,许小立,李彦豪.CO2-DSA研究新进展.生物医学工程与临床,2002,6(1):55-58.
[34]杜海军,应争先,王煜.二氧化碳在数字减影血管造影中的临床应用.临床医学,2007,27(11):33-35.
[35]Kessel DO,Robertson I,Patel J,et al.Carbon-dioxide-guided vascular interventions:technique and pitfalls.Cardiovasc Intervent Radiol,2002,25(6):476-83.
[36]Bretthauer M,Hoff G,Thiis-Evensen E,et al.Carbon dioxide insuffiation reduces discomfort due to flexible sigmoidoscopy in colorectal cancer screening.Scand J Gastroenterol,2002,37(9):1103-7.
[37]Bretthauer M,Hoff GS,Thiis-Evensen E,et al.Air and carbon dioxide volumes insufflated during colonoscopy. Gastrointest Endosc, 2003, 58(2):203-6.
[38] Nakajima K, Yasumasa K, Endo S, et al. A versatile dual-channel carbon dioxide (CO2) insufflator for various CO2)applications. The prototype. Surg Endosc,2006,20(2):334-8.
[39] Sumanac K, Rawlinson J, Salena B. carbon dioxide (CO2) vs room air (RA) insufflation for colonoscopy: A randomized double-blind controlled trial.Gastrointest Endosc, 2001, 53(5): AB76.
[40] Bretthauer M, Lynge AB, et al. Carbon Dioxide Insufflation in Colonoscopy:Safe and Effective in Sedated Patients. Endoscopy, 2005, 37: 706-709.
[41] Nakajima K, Lee SW, Sonoda T, et al. Intraoperative carbon dioxide colonoscopy: a safe insufflation alternative for locating colonic lesions during laparoscopic surgery. Surg Endosc, 2005,19: 321-325.
[42] Khan MH, Kessler W, Khashab M. Toward Painless Colonoscopy: Propofol Plus Carbon Dioxide. Gastrointest Endosc, 2005, 61(5:) AB230.
[43] Domagk D, Bretthauer M, Lenz P, et al. Carbon dioxide insufflation improves intubation depth in double-balloon enteroscopy: a randomized, controlled,double-blind trial. Endoscopy, 2007, 39(12):1064-7.
[44] Saito Y, Uraoka T, Matsuda T, et al. A pilot study to assess the safety and efficacy of carbon dioxide insufflation during colorectal endoscopic submucosal dissection with the patient under conscious sedation.Gastrointest Endosc, 2007,65(3):537-42.
[45] Bretthauer M, Seip B, Aasen S, et al. Carbon dioxide insufflation for more comfortable endoscopic retrograde cholangiopancreatography: a randomized,controlled, double-blind trial. Endoscopy, 2007, 39(1):58-64.
[46] Rogers BH. The safety of carbon dioxide insufflation during colonoscopic electrosurgical polypectomy.Gastrointest Endosc, 1974,20(3): 115-7.
[47] Rogers BH. Carbon dioxide for colonoscopy. Gastroenterology, 1980,78(6): 1659-60.
[48] Rogers BH. CO2 during colonoscopy for safety and comfort. Gastrointest Endosc, 1985, 31(2):108-9.
[49] Macrae FA, Tan KG, Williams CB. Towards safer colonoscopy: a report on the complications of 5000 diagnostic or therapeutic. colonoscopies. Gut, 1983,24:376-83
[50] Hussein AM, Bartram CI, Williams CB. Carbon dioxide insufflation for more comfortable colonoscopy. Gastrointest Endosc, 1984, 30(2):68-70.
[51] Phaosawasdi K, Cooley W, Wheeler J, et al. Carbon dioxide-insufflated colonoscopy: an ignored superior technique. Gastrointest Endosc, 1986,32(5):330-3.
[52] Goldman JM. A simple, easy, and inexpensive method for monitoring ETCO2 through nasal canulae. Anesthesiology, 1987, 67:606.
[53] Bretthauer M, Hoff G. The use of CO2 in colonoscopy. Gastrointest Endosc,2003, 57(3): 436-7.
[54] Montorsi M, Opocher E, Santambrogio R, et al. Original technique for small colorectal tumor localization during laparoscopic surgery. Dis Colon Rectum,1999,42:819-822.
[2] Cappell MS, Friedel D, et al. The role of sigmoidoscopy and colonoscopy in the diagnosis and management of lower gastrointestinal disorders: endoscopic findings, therapy, and complications. Med Clin North Am, 2002 Nov; 86(6): 1253-1288.
[3] Huang EH, Marks JM, et al. The diagnostic and therapeutic roles of colonoscopy: a review. Surg Endosc,2001 Oct; 15: 1373-1380.
[4] Zmora O, Dinnewitzer AJ, Pikarsky AJ, et al. Intraoperative endoscopy in laparoscopic colectomy. Surg Endosc, 2002 Feb; 16: 808-811.
[5] Church J, Delaney C, et al. Randomized, controlled trial of carbon dioxide insufflation during colonoscopy. Dis Colon Rectum, 2003; 46: 322-326.
[6] Bretthauer M, Thiis-Evensen E, Huppertz-Hauss G, et al. NORCCAP (Norwegian Colorectal Cancer Prevention): a randomised trial to assess the safety and efficacy of carbon dioxide versus air insufflation in colonoscopy. Gut, 2002; 50: 604-607.
[7] Stevenson GW, Wilson JA, Wilkinson J, et al. Pain following colonoscopy: elimination with carbon dioxide. Gastrointest Endosc, 1992; 38: 564-567.
[8] Sumanac K, Zealley I, Fox BM, et al. Minimizing postcolonoscopy abdominal pain by using CO(2) insufflation: a prospective, randomized, double blind, controlled trial evaluating a new commercially available CO(2) delivery system. Gastrointest Endosc, 2002; 56: 190-194.
[9] Katzgraber F, Glenewinkel F, Fischler S, et al. Mechanism of fatal air embolism after gastrointestinal endoscopy. Int J Legal Med, 1998; 111: 154-156.
[10] Arhan P, Bouchoucha M, Martelli H, et al. Relationship between parietal blood flow studies in the left colon and the rectum in dogs. Colonic pressure and blood flow. Dis Colon Rectum, 1988; 31: 54-57
[11] Yasumasa K, Nakajima K, Endo S, et al. Carbon dioxide insufflation attenuates parietal blood flow obstruction in distended colon. Surg Endosc, 2006 Apr;20(4):587-94.
[12] Kim SH, Milsom JW, Church JM, et al. Perioperative tumor localization for laparoscopic colorectal surgery. Surg Endosc, 1997; 11: 1013-1016.
[13] Carter HG. Explosion in the colon during electrodesiccation of polyps. Am J Surg ,1952; 11:514-16.
[14] Becker GL. Prevention of gas explosions in the large bowel duringelectrosurgery. Surg Gynecol Obstet, 1953; 97:463.
[15] Ladas SD, Karamanolis G, Ben-Soussan E. Colonic gas explosion during therapeutic colonoscopy with electrocautery. World J Gastroenterol. 2007,13(40):5295-8.
[16] Roberts MW, Mathiesen KA, Ho HS, et al. Cardiopulmonary responses to intravenous infusion of soluble and relatively insoluble gases. Surg Endosc, 1997;11:341-346.
[17] Saltzman HA, Sieker HO, et al. Intestinal response to changing gaseous environments: normobaric and hyperbaric observations. Ann N Y Acad Sci, 1968;150: 31-39.
[18] Uen YH, Chen Y, Kuo CY, et al. Randomized trial of low-pressure carbon dioxide-elicited pneumoperitoneum versus abdominal wall lifting for laparoscopic cholecystectomy. J Chin Med Assoc, 2007, 70(8):324-30.
[19] Scullion DA, Wetton CW, Davies C, et al. The use of air or CO2 as insufflation agents for double contrast barium enema (DCBE): is there a qualitative difference? Clin Radiol, 1995, 50(8):558-61.
[20] Kessel DO, Robertson I, Patel J, et al. Carbon-dioxide-guided vascular interventions: technique and pitfalls. Cardiovasc Intervent Radiol, 2002, 25(6):476-83.
[21] Magno R, Medegard A, Bengtsson R, et al. Acid base balance during laparoscopy: The effect of intraperitoneal insufflation of carbon dioxide and nitrous oxide on acid-base balance during controlled ventilation. Acta Obstet Gynecol Scand,1979; 58:81-5.
[22] Nesek-Adam V, Mrsic V, Smiljanic A, et al. Pathophysiologic effects of CO2 pneumoperitoneum in laparoscopic surgery. Acta Med Croatica, 2007,61(2):165-70.
[23] Rogers BH. The safety of carbon dioxide insufflation during colonoscopic electrosurgical polypectomy. Gastrointest Endosc, 1974, 20(3):115-7.
[24] Rogers BH. Carbon dioxide for colonoscopy. Gastroenterology, 1980,78(6):1659-60.
[25] Rogers BH. CO2 during colonoscopy for safety and comfort. Gastrointest Endosc, 1985, 31(2): 108-9.
[26] Bretthauer M, Hoff G, Thiis-Evensen E, et al. Carbon dioxide insufflation reduces discomfort due to flexible sigmoidoscopy in colorectal cancer screening. Scand J Gastroenterol, 2002, 37(9): 1103-7.
[27] Goldman JM. A simple, easy, and inexpensive method for monitoring ETCO2 through nasal canulae. Anesthesiology, 1987, 67:606.
[28] Bretthauer M, Hoff G. The use of CO2 in colonoscopy. Gastrointest Endosc, 2003, 57(3): 436-7.
[29] Bretthauer M, Lynge AB, et al. Carbon Dioxide Insufflation in Colonoscopy: Safe and Effective in Sedated Patients. Endoscopy, 2005; 37: 706-709.
[30] Sumanac K, Rawlinson J, Salena B. carbon dioxide (CO2) vs room air (RA) insufflation for colonoscopy: A randomized double-blind controlled trial. Gastrointest Endosc, 2001, 53(5): AB76.
[31] Nakajima K, Lee SW, Sonoda T, et al. Intraoperative carbon dioxide colonoscopy:a safe insufflation alternative for locating colonic lesions during laparoscopic surgery. Surg Endosc, 2005; 19: 321-325.
[32] Domagk D, Bretthauer M, Lenz P, et al. Carbon dioxide insufflation improves intubation depth in double-balloon enteroscopy: a randomized, controlled,double-blind trial. Endoscopy, 2007, 39(12):1064-7.
[33] Saito Y, Uraoka T, Matsuda T, et al. A pilot study to assess the safety and efficacy of carbon dioxide insufflation during colorectal endoscopic submucosal dissection with the patient under conscious sedation. Gastrointest Endosc, 2007, 65(3):537-42.
[34] Bretthauer M, Seip B, Aasen S, et al. Carbon dioxide insufflation for more comfortable endoscopic retrograde cholangiopancreatography: a randomized, controlled, double-blind trial. Endoscopy, 2007, 39(1):58-64.
[35] Bretthauer M, Hoff GS, Thiis-Evensen E, et al. Air and carbon dioxide volumes insufflated during colonoscopy. Gastrointest Endosc, 2003, 58(2):203-6.
[36] Katzgraber F, Glenewinkel F, Fishchler S, et al. Mechanism of fatal air embolism after gastrointestinal endoscopy. Int J Legal Med, 1998,111:154-156.
[37] Thiis-Evensen E, Hoff G, Sauar J, Vatn MH. Patient tolerance of colonoscopy without sedation during screening examination for colorectal polyps.Gastrointest Endosc, 2000, 52:606-10.
[38] Fu C, Li GY, Liu FY, et al. Effect of carbon dioxide pneumoperitoneum laparoscopic surgery on tumor seeding and metastases in endometrial cancer. Zhong Nan Da Xue Xue Bao Yi Xue Ban, 2008, 33(2): 130-7.
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[42] Williams CB. Who's for CO2? Gastrointest Endosc, 1986, 32:365-7.
[43] Nakajima K, Yasumasa K, Endo S, et al. A versatile dual-channel carbon dioxide (CO2) insufflator for various CO2)applications. The prototype. Surg Endosc, 2006, 20(2):334-8.
[1] Wolff WI. Colonoscopy: history and development. Am J Gastroenterol, 1989,84(9): 1017-25.
[2] Cappell MS, Friedel D. The role of sigmoidoscopy and colonoscopy in the diagnosis and management of lower gastrointestinal disorders: endoscopic findings, therapy, and complications. Med Clin North Am, 2002, 86(6):1253-1288.
[3] Huang EH, Marks JM. The diagnostic and therapeutic roles of colonoscopy: a review. Surg Endosc, 2001, 15: 1373-1380.
[4] Waye JD. Colonoscopy. CA Cancer J Clin, 1992,42: 350-365.
[5] Zmora O, Dinnewitzer AJ, Pikarsky AJ, et al. Intraoperative endoscopy in laparoscopic colectomy. Surg Endosc, 2002,16: 808-811.
[6] Church J, Delaney C. Randomized, controlled trial of carbon dioxide insufflation during colonoscopy. Dis Colon Rectum, 2003,46: 322-326.
[7] Bretthauer M, Thiis-Evensen E, Huppertz-Hauss G, et al. NORCCAP (Norwegian Colorectal Cancer Prevention): a randomised trial to assess the safety and efficacy of carbon dioxide versus air insufflation in colonoscopy. Gut, 2002, 50:604-607.
[8] Stevenson GW, Wilson JA, Wilkinson J, et al. Pain following colonoscopy: elimination with carbon dioxide. Gastrointest Endosc, 1992, 38: 564-567.
[9] Sumanac K, Zealley I, Fox BM, et al. Minimizing postcolonoscopy abdominal pain by using CO(2) insufflation: a prospective, randomized, double blind,controlled trial evaluating a new commercially available CO(2) delivery system. Gastrointest Endosc, 2002, 56: 190-194.
[10] Katzgraber F, Glenewinkel F, Fischler S, et al. Mechanism of fatal air embolism after gastrointestinal endoscopy. Int J Legal Med, 1998, 111: 154-156.
[11] Arhan P, Bouchoucha M, Martelli H, et al. Relationship between parietal blood flow studies in the left colon and the rectum in dogs. Colonic pressure and blood flow.Dis Colon Rectum,1988,31:54-57
[12]Boley SJ,Agrawal GP,Warren AR,et al.Pathophysiologic effects of bowel distention on intestinal blood flow.Am J Surg,1969,117:228-234.
[13]Yasumasa K,Nakajima K,Endo S,et al.Carbon dioxide insufflation attenuates parietal blood flow obstruction in distended colon.Surg Endosc,2006,20(4):587-94.
[14]Kim SH,Milsom JW,Church JM,et al.Perioperative tumor localization for laparoscopic colorectal surgery.Surg Endosc,1997,11:1013-1016.
[15]Carter HG.Explosion in the colon during electrodesiccation of polyps.Am J Surg,1952,11:514-16.
[16]Kim SH,Milsom JW,Church JM,et al.Perioperative tumor localization for laparoscopic colorectal surgery.Surg Endosc,1997,11:1013-1016.
[17]Ladas SD,Karamanolis G;Ben-Soussan E.Colonic gas explosion during therapeutic colonoscopy with electrocautery.World J Gastroenterol.2007,13(40):5295-8.
[18]Becker GL.Prevention of gas explosions in the large bowel duringelectrosurgery.Surg Gynecol Obstet,1953,97:463.
[19]曹月敏主编.腹腔镜外科学.石家庄:河北科技出版社,1999,192.
[20]Williams CB.Who's for CO2? Gastrointest Endosc,1986,32:365-7.
[21]Roberts MW,Mathiesen KA,Ho HS,et al.Cardiopulmonary responses to intravenous infusion of soluble and relatively insoluble gases.Surg Endosc,1997,11:341-346.
[22]Saltzman HA,Sieker HO,et al.Intestinal response to changing gaseous environments:normobaric and hyperbaric observations.Ann N Y Acad Sci,1968,150:31-39.
[23]Holthausen UH,Nagelschmidt M,Troidl H.CO(2)pneumoperitoneum:what we know and what we need to know.World J Surg,1999,23(8):794-800.
[24]Wolf JS Jr.Pathophysiologic effects of prolonged laparoscopicoperation.Semin Surg Oncol,1996,12:86-95.
[25]Nesek-Adam V,Mrsic V,Smiljanic A,et al.Pathophysiologic effects of CO2 pneumoperitoneum in laparoscopic surgery.Acta Med Croatica,2007,61(2):165-70.
[26]Southern DA,Mapleson WW.Which insuffiation gas for laparoscopy.BMJ.1993,27;307(6916):1424.
[27]丁晓曼,冷金花,郎景和.二氧化碳气腹对机体的影响.中华妇产科杂志,2001,36(3):185-186.
[28]Uen YH,Chen Y,Kuo CY,et al.Randomized trial of low-pressure carbon dioxide-elicited pneumoperitoneum versus abdominal wall lifting for laparoscopic cholecystectomy.J Chin Med Assoc,2007,70(8):324-30.
[29]Scullion DA,Wetton CW,Davies C,et al.The use of air or CO2 as insuffiation agents for double contrast barium enema(DCBE):is there a qualitative difference? Clin Radiol,1995,50(8):558-61.
[30]Robson NK,Lloyd M,Regan F.The use of carbon dioxide as an insuffiation agent in barium enema-does it have a role? Br J Radiol,1993,66(783):197-8.
[31]Gellett LR,Farrow R,Bloor C,et al.Pain after small bowel meal and pneumocolon:a randomized controlled trial of carbon dioxide versus air insuffiation.Clin Radiol,1999,54(6):381-3.
[32]Hawkins IF.Carbon dioxide digital subtraction angiography.AJR Am J Roentgenol,1982,139(1):19-24.
[33]卢伟,许小立,李彦豪.CO2-DSA研究新进展.生物医学工程与临床,2002,6(1):55-58.
[34]杜海军,应争先,王煜.二氧化碳在数字减影血管造影中的临床应用.临床医学,2007,27(11):33-35.
[35]Kessel DO,Robertson I,Patel J,et al.Carbon-dioxide-guided vascular interventions:technique and pitfalls.Cardiovasc Intervent Radiol,2002,25(6):476-83.
[36]Bretthauer M,Hoff G,Thiis-Evensen E,et al.Carbon dioxide insuffiation reduces discomfort due to flexible sigmoidoscopy in colorectal cancer screening.Scand J Gastroenterol,2002,37(9):1103-7.
[37]Bretthauer M,Hoff GS,Thiis-Evensen E,et al.Air and carbon dioxide volumes insufflated during colonoscopy. Gastrointest Endosc, 2003, 58(2):203-6.
[38] Nakajima K, Yasumasa K, Endo S, et al. A versatile dual-channel carbon dioxide (CO2) insufflator for various CO2)applications. The prototype. Surg Endosc,2006,20(2):334-8.
[39] Sumanac K, Rawlinson J, Salena B. carbon dioxide (CO2) vs room air (RA) insufflation for colonoscopy: A randomized double-blind controlled trial.Gastrointest Endosc, 2001, 53(5): AB76.
[40] Bretthauer M, Lynge AB, et al. Carbon Dioxide Insufflation in Colonoscopy:Safe and Effective in Sedated Patients. Endoscopy, 2005, 37: 706-709.
[41] Nakajima K, Lee SW, Sonoda T, et al. Intraoperative carbon dioxide colonoscopy: a safe insufflation alternative for locating colonic lesions during laparoscopic surgery. Surg Endosc, 2005,19: 321-325.
[42] Khan MH, Kessler W, Khashab M. Toward Painless Colonoscopy: Propofol Plus Carbon Dioxide. Gastrointest Endosc, 2005, 61(5:) AB230.
[43] Domagk D, Bretthauer M, Lenz P, et al. Carbon dioxide insufflation improves intubation depth in double-balloon enteroscopy: a randomized, controlled,double-blind trial. Endoscopy, 2007, 39(12):1064-7.
[44] Saito Y, Uraoka T, Matsuda T, et al. A pilot study to assess the safety and efficacy of carbon dioxide insufflation during colorectal endoscopic submucosal dissection with the patient under conscious sedation.Gastrointest Endosc, 2007,65(3):537-42.
[45] Bretthauer M, Seip B, Aasen S, et al. Carbon dioxide insufflation for more comfortable endoscopic retrograde cholangiopancreatography: a randomized,controlled, double-blind trial. Endoscopy, 2007, 39(1):58-64.
[46] Rogers BH. The safety of carbon dioxide insufflation during colonoscopic electrosurgical polypectomy.Gastrointest Endosc, 1974,20(3): 115-7.
[47] Rogers BH. Carbon dioxide for colonoscopy. Gastroenterology, 1980,78(6): 1659-60.
[48] Rogers BH. CO2 during colonoscopy for safety and comfort. Gastrointest Endosc, 1985, 31(2):108-9.
[49] Macrae FA, Tan KG, Williams CB. Towards safer colonoscopy: a report on the complications of 5000 diagnostic or therapeutic. colonoscopies. Gut, 1983,24:376-83
[50] Hussein AM, Bartram CI, Williams CB. Carbon dioxide insufflation for more comfortable colonoscopy. Gastrointest Endosc, 1984, 30(2):68-70.
[51] Phaosawasdi K, Cooley W, Wheeler J, et al. Carbon dioxide-insufflated colonoscopy: an ignored superior technique. Gastrointest Endosc, 1986,32(5):330-3.
[52] Goldman JM. A simple, easy, and inexpensive method for monitoring ETCO2 through nasal canulae. Anesthesiology, 1987, 67:606.
[53] Bretthauer M, Hoff G. The use of CO2 in colonoscopy. Gastrointest Endosc,2003, 57(3): 436-7.
[54] Montorsi M, Opocher E, Santambrogio R, et al. Original technique for small colorectal tumor localization during laparoscopic surgery. Dis Colon Rectum,1999,42:819-822.