论坛 › 内蒙古 › 注水肠镜合集以及技巧大全注意事项（包含视频及工藤教授的肠镜技巧及书籍）

f9yx0du 发表于 2024-7-20 22:38:31

注水肠镜合集以及技巧大全注意事项（包含视频及工藤教授的肠镜技巧及书籍）

    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;">注水肠镜合集以及技巧大全<span style="color: black;">重视</span>事项（<span style="color: black;">包含</span>视频及工藤教授的肠镜技巧及书籍）</a></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">在日本研修<span style="color: black;">时期</span>，<span style="color: black;">非常多</span>肠镜都是非<span style="color: black;">麻木</span>下进行的，小伙伴们有些听了可能会菊花一紧；其实真正的5级工高级<span style="color: black;">熟悉</span>者普通肠镜的舒适度比<span style="color: black;">麻木</span>效果要好的多，不少<span style="color: black;">检测</span>者<span style="color: black;">能够</span>玩着手机，做着自己的事情将肠镜完成（个人认为注水肠镜会像单人肠镜划时代双人肠镜<span style="color: black;">同样</span>，划时代注气肠镜）；尤其是注水肠镜让<span style="color: black;">非常多</span>人觉得肚子热热的（提醒<span style="color: black;">大众</span><span style="color: black;">必定</span>要用温水，<span style="color: black;">大众</span><span style="color: black;">晓得</span>日本<span style="color: black;">针对</span>细节的<span style="color: black;">掌控</span>是非常的，<span style="color: black;">意见</span><span style="color: black;">大众</span>附送水以及去泡水都要<span style="color: black;">选择</span><span style="color: black;">病人</span>比较事宜的温水，这个<span style="color: black;">能够</span>在预约时提前跟<span style="color: black;">病人</span>预约温水的温度，<span style="color: black;">这般</span><span style="color: black;">能够</span>让<span style="color: black;">检测</span>者感觉到仁性关怀，<span style="color: black;">尤其</span>是双气囊小肠镜利用注水<span style="color: black;">优良</span><span style="color: black;">亦</span>更大），非常的舒服，像洗了个桑拿腹部热敷按摩了一下。个人觉得<span style="color: black;">针对</span>单人注水肠镜<span style="color: black;">针对</span>循腔进镜，以及病变的拍摄与治疗<span style="color: black;">优良</span>是非常大的。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/6KSS73FrqBZNTmxTEOlEyJjwfTa30HqszQd504Eicn4Og4zWe0sGBR6f5PDicDQOBv7uOtl92aVsea0oYgWPs8tQ/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/6KSS73FrqBZNTmxTEOlEyJjwfTa30Hqs6082p5Sl4nmYIkKL6PJEib7IAKEPUdsQsb9P4FFKuayjDicicK8m0aLcA/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/6KSS73FrqBZNTmxTEOlEyJjwfTa30Hqsz6ZPPXQZvOXQW2ecW8KqiaPAZic7ktvnKOUug0DPOjRTxxSWXpRPicWpw/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/6KSS73FrqBZNTmxTEOlEyJjwfTa30HqsTQXChGYtDgKTVb1PdSzBSHxfQC7Luia5pHPXSoib4TyWicxOamibdibJibdg/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/6KSS73FrqBZNTmxTEOlEyJjwfTa30Hqsgugy2KAVzlv9Gj1HGroXXpl69oWVo8WHMicydejv32vPQczULSeWibaA/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">就像图上<span style="color: black;">表示</span>的<span style="color: black;">同样</span>肠道的腔开的非常好，<span style="color: black;">况且</span><span style="color: black;">无</span>锐利的<span style="color: black;">状况</span>。<span style="color: black;">况且</span>拍摄病变会更清晰，<span style="color: black;">尤其</span>是<span style="color: black;">针对</span>SA &nbsp;pit pattern的判定是非常有好处的。水下的治疗不管<span style="color: black;">针对</span>冷切还是热切都相当于有<span style="color: black;">必定</span>的抬举与吸收热量，<span style="color: black;">针对</span>黏膜下的<span style="color: black;">守护</span>是<span style="color: black;">不问可知</span>的。</span></p>
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    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">EUEMR是日本一种非常流行的EMR方式。在内镜下切除息肉时，水<span style="color: black;">能够</span>充当一种天然的安全<span style="color: black;">守护</span>，使粘膜及粘膜下层相<span style="color: black;">针对</span>固有肌层<span style="color: black;">来讲</span><span style="color: black;">处在</span>“漂浮”状态，尤其适用于大的、广基的息肉切除。EUEMR能够完整切除比传统EMR更大的病变，<span style="color: black;">况且</span>安全性高，手术<span style="color: black;">流血</span>和穿孔的<span style="color: black;">出现</span>率均较传统EMR低。操作相对简单，对技术<span style="color: black;">需求</span>低，耗时短。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">就像下面这个病变水下的拍摄与EUEMR的安全性都是非常确切。</p>

    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/6KSS73FrqBZNTmxTEOlEyJjwfTa30HqsU5ic82IGv0tV6POJVw9Qiccl3q0ibHrOQwGYKz7bfNxUzEqQXohkxWJ7g/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/6KSS73FrqBZNTmxTEOlEyJjwfTa30HqsSSGbY3vIiaBgVR6KLBw7Bl7o68ozQjGJbrdo6hQia7gwvMnXibsh7kPlw/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/6KSS73FrqBZNTmxTEOlEyJjwfTa30Hqs6tcG96kPkibV9iaPvGJQYjISrw260oibria4RCktcY6EpH31PmINWyYib3g/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">后藤利夫教授是水浸法的创始人：水浸法肠镜<span style="color: black;">检测</span>在<span style="color: black;">插进</span>内视镜时用少量的水代替气体，他风趣地说潜水艇虽然很重，却<span style="color: black;">能够</span>浮出水面，内视镜<span style="color: black;">亦</span>是<span style="color: black;">一样</span>道理，它有<span style="color: black;">必定</span>的重量，但在水环境中会变得相对更轻，推进时就不<span style="color: black;">必须</span><span style="color: black;">那样</span>用力，避免<span style="color: black;">导致</span>肠壁的拉扯。<span style="color: black;">另一</span>，有了水的润滑，<span style="color: black;">亦</span>可减少与肠壁的摩擦，能够大大降低<span style="color: black;">病痛</span>感。<span style="color: black;">况且</span>水会让镜子与肠壁保持<span style="color: black;">必定</span>的距离不至于贴着肠壁，<span style="color: black;">尤其</span>是温水会使肠子<span style="color: black;">处在</span><span style="color: black;">尤其</span>舒适的腔，难么<span style="color: black;">咱们</span>的手技能得到更好的发挥。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">后藤教授介绍到<span style="color: black;">日前</span>为止，接受水浸法肠镜<span style="color: black;">检测</span>的大部分客户感受是“几乎<span style="color: black;">无</span>痛感”、“不怎么有痛感”、“略有痛感”。“有<span style="color: black;">必定</span>痛感”和“非常痛”的比例仅占5%。<span style="color: black;">由于</span><span style="color: black;">每一个</span>人结肠的长度及形状都有差异，<span style="color: black;">一般</span><span style="color: black;">状况</span>下，偏瘦的人结肠偏长、有过腹部手术（肠粘连）的人容易<span style="color: black;">显现</span><span style="color: black;">病痛</span>感。<span style="color: black;">然则</span>这些<span style="color: black;">病人</span>提前应用解痉灵，<span style="color: black;">尤其</span>是温水效果是非常好的。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/6KSS73FrqBaQSsbslTKticEeUjYiajgVNbA7hnXt4nyIkZPSBqCEJ6deCdy2DwdUwSONf55NqRSvIdjPVstdNFmQ/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/6KSS73FrqBaQSsbslTKticEeUjYiajgVNbkuoo62iaLetFibpOARa07lPJaDDVC1bKRhuHD9vW1WYqAHWR1zEGOMSw/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
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    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/6KSS73FrqBaQSsbslTKticEeUjYiajgVNbiaSxUlWs8sUicUTp4f5DyYKoGqdXnKdqYCgyy32jib6fPXzuJd4vcKD8w/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
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    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">大众</span>看了这个视频后是不是感觉全程都是无袢的，其实初学者的难点<span style="color: black;">便是</span>乙状结肠，温水注水法确实使乙状结肠确实拉直无袢了。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">传统结肠确<span style="color: black;">检测</span><span style="color: black;">经过</span>向肠</span></span><span style="color: black;"><span style="color: black;">腔</span></span><span style="color: black;"><span style="color: black;">内注入空气以暴</span></span><span style="color: black;"><span style="color: black;">露</span></span><span style="color: black;"><span style="color: black;">肠腔，<span style="color: black;">而后</span>进行插镜<span style="color: black;">检测</span>，这种<span style="color: black;">检测</span><span style="color: black;">办法</span>容易注气<span style="color: black;">太多</span>，使肠道延长成角，<span style="color: black;">增多</span>结肠镜操作的困难，部分<span style="color: black;">病人</span>疼癌难忍<span style="color: black;">导致</span><span style="color: black;">没法</span>耐受<span style="color: black;">检测</span>。随看<span style="color: black;">麻木</span>技术的<span style="color: black;">持续</span>发展，近些年来，在<span style="color: black;">麻木</span>状态下，<span style="color: black;">病人</span>行结肠镜<span style="color: black;">检测</span>时的舒适度会<span style="color: black;">显著</span><span style="color: black;">加强</span>，<span style="color: black;">然则</span>跟普通肠镜相比较，除了<span style="color: black;">必须</span>耗费<span style="color: black;">更加多</span>的人力及物力成</span></span><span style="color: black;"><span style="color: black;">本</span></span><span style="color: black;"><span style="color: black;">，<span style="color: black;">麻木</span>下结肠镜又<span style="color: black;">增多</span>了<span style="color: black;">麻木</span>的<span style="color: black;">危害</span>，尤其对心肺功能<span style="color: black;">欠好</span>的老年<span style="color: black;">病人</span>危险性就会<span style="color: black;">更加是</span>会大大增力加。<span style="color: black;">同期</span><span style="color: black;">麻木</span>下结</span></span><span style="color: black;"><span style="color: black;">肠</span></span><span style="color: black;"><span style="color: black;">镜<span style="color: black;">检测</span>难以观察<span style="color: black;">病人</span>的表情变化，<span style="color: black;">没法</span>准确<span style="color: black;">把握</span><span style="color: black;">病人</span>的耐受力和<span style="color: black;">即时</span>预防并发症<span style="color: black;">出现</span>，部分<span style="color: black;">病人</span>会在<span style="color: black;">检测</span>过程中<span style="color: black;">显现</span><span style="color: black;">区别</span>程度心率减慢、血压下降和<span style="color: black;">呼气</span>暂停，<span style="color: black;">因此</span>影响了<span style="color: black;">麻木</span>结肠镜在临床中的发挥</span>"<span style="color: black;">，<span style="color: black;">因此呢</span>应用注水结肠镜<span style="color: black;">检测</span>能够<span style="color: black;">加强</span>肠系<span style="color: black;">疾患</span>的检出率，尤其是结肠近</span></span><span style="color: black;"><span style="color: black;">端</span></span><span style="color: black;"><span style="color: black;">部位的腺瘤。注水结肠镜<span style="color: black;">检测</span>时，灌注温水可避免结肠痉挛，减少成角，缓解腹病</span>;<span style="color: black;">当<span style="color: black;">病人</span>采取左侧卧位时，<span style="color: black;">因为</span>重力<span style="color: black;">功效</span>，水流向低位降结肠，拉直了乙状结肠弯曲，乙状结肠肠系膜牵拉减少，使<span style="color: black;">病人</span>不适感降低，开放了通往乙状结肠环的通道，结肠镜更易无晕<span style="color: black;">经过</span>，避免了注气法中乙状结肠气袋<span style="color: black;">提升</span>至<span style="color: black;">病人</span>右侧，使乙状结肠更加扭曲的这一缺点，减少<span style="color: black;">检测</span>时的副<span style="color: black;">功效</span>。在结肠注水后，因灭菌注射用水或生理盐水加用了盐酸丁卡因内镜润滑剂，起到了较好的去泡效果，使肠道清洁度<span style="color: black;">显著</span><span style="color: black;">增多</span>，内镜视野<span style="color: black;">显出</span>更近，更清晰，<span style="color: black;">从而</span>能<span style="color: black;">加强</span><span style="color: black;">疾患</span>的检出率。对结肠应前病变人群有效监控，将为结肠癌癌前病变的<span style="color: black;">干涉</span><span style="color: black;">供给</span><span style="color: black;">靠谱</span>医学<span style="color: black;">基本</span>，<span style="color: black;">亦</span>有望大幅<span style="color: black;">加强</span><span style="color: black;">初期</span>结肠癌的诊断率，其社会经济效益<span style="color: black;">不问可知</span>。</span></span><span style="color: black;"><span style="color: black;">我在日本研修<span style="color: black;">时期</span><span style="color: black;">通常</span>都是温盐水加少量的去泡剂</span></span><span style="color: black;">300ml-500ml<span style="color: black;">提前注入，有人可能会浪费时间，但日本多中心<span style="color: black;">科研</span>，还有<span style="color: black;">自己</span>的体会操作，<span style="color: black;">尤其</span>是肠道气泡多的<span style="color: black;">病人</span>，减少了再次冲洗的时间，<span style="color: black;">况且</span><span style="color: black;">针对</span>病变的检出率与治疗率都是<span style="color: black;">增多</span>的。水中拍摄息肉其实是非常清晰的，避免了反光，<span style="color: black;">况且</span><span style="color: black;">亦</span>让病变<span style="color: black;">全部</span><span style="color: black;">表示</span><span style="color: black;">尤其</span>好，下一步治疗<span style="color: black;">亦</span>就好了。</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/6KSS73FrqBbbt8iarfkPICBRKuibQEpDmwWicPPicO0UJGIsHFNxBKljZ4MBXkF0HMM3lAmBvvFSWte4enVDhyhDsw/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/6KSS73FrqBbbt8iarfkPICBRKuibQEpDmwI9bMYg0DPGPhwydBAs7htHH54ZIWeRKCN3LL0Ca0MYhMUjhXOxX8ibw/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/6KSS73FrqBbbt8iarfkPICBRKuibQEpDmw2t5qkfaDvo4aZKvuWAwTrpYichaD3qicia0LldrwGNNhorB7rglo8yAZA/640?wx_fmt=jpeg&amp;tp=webp&amp;wxfrom=5&amp;wx_lazy=1&amp;wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">我<span style="color: black;">通常</span>的习惯利用透明帽联合注水法，<span style="color: black;">由于</span></span></span><span style="color: black;"><span style="color: black;">透明帽联合注水法减轻了受检者的痛苦，但在减轻黏膜<span style="color: black;">损害</span><span style="color: black;">出现</span>率并无<span style="color: black;">优良</span>。进镜时所<span style="color: black;">导致</span>黏膜<span style="color: black;">损害</span>为进镜时透明帽、内镜前端或镜身与肠黏膜钝性接触<span style="color: black;">导致</span>，以轻度黏膜充血、红斑或轻度黏膜破损为<span style="color: black;">重点</span>表现。透明帽联合注水法可<span style="color: black;">经过</span>注入温水来暴露肠腔走向，灌注温水可缓解结肠痉宰，减少成角，降低受检者的不适感。<span style="color: black;">因为</span>肠道对牵拉比较<span style="color: black;">敏锐</span>，注水<span style="color: black;">能够</span>润滑肠道，减少了对肠管的过分牵拉和起</span></span><span style="color: black;"><span style="color: black;">袢</span></span><span style="color: black;"><span style="color: black;">，有助于结肠镜无祥<span style="color: black;">经过</span>乙状结肠，降低对结肠肠系膜的牵拉，从而减少</span></span><span style="color: black;"><span style="color: black;"><span style="color: black;">病痛</span></span></span><span style="color: black;"><span style="color: black;">。总之，透明帽联合注水法缩短了插镜时间，减轻受检者痛苦，<span style="color: black;">加强</span>了大肠腺瘤检出率高。但其在退镜时间上相对较长，在插镜深度、插镜成功率及黏膜<span style="color: black;">损害</span><span style="color: black;">出现</span>率方面，</span></span><span style="color: black;"><span style="color: black;"><span style="color: black;">因此呢</span><span style="color: black;">意见</span><span style="color: black;">大众</span>还是<span style="color: black;">尽可能</span>螺旋退镜，精细操作，让手技到达最佳，有人说我做肠镜像绣花<span style="color: black;">同样</span>，其实我觉得这<span style="color: black;">便是</span>非常精细的操作，<span style="color: black;">尽可能</span>的展现绣花手技，其实越轻柔<span style="color: black;">病人</span>越舒适，<span style="color: black;">咱们</span>操作治疗的会越快。</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">其实注水肠镜<span style="color: black;">针对</span>初学者是非常好的，<span style="color: black;">由于</span>注气辅助结肠镜是传统的结肠镜<span style="color: black;">检测</span><span style="color: black;">办法</span>，<span style="color: black;">检测</span>过程中辅以腹部按压、体位变换</span>"<span style="color: black;">，但易<span style="color: black;">显现</span>注气<span style="color: black;">太多</span>，延长肠道，<span style="color: black;">增多</span>肠道成祥，<span style="color: black;">引起</span>进镜闲难。部分<span style="color: black;">病人</span>腹胀、腹痛<span style="color: black;">显著</span>，终止诊疗、拒绝复查现象较多，阻碍了结肠镜<span style="color: black;">检测</span>的普及及肠道肿瘤的筛查力度。注水辅助结肠镜<span style="color: black;">检测</span>以注水代替注气暴露肠腔的走行，肠管所受压力降低，减少成袢，且水流在重力的<span style="color: black;">功效</span>下流向降结肠，乙状结肠受降结肠拉力<span style="color: black;">功效</span>被拉伸，减少了肠系膜的牵拉<span style="color: black;">引起</span>的不适感，结肠镜<span style="color: black;">更易</span><span style="color: black;">经过</span>乙状结肠环和左半结肠</span><span style="color: black;">;</span><span style="color: black;">且在注水过程中可<span style="color: black;">运用</span>温水安抚肠道，缓解疼挛、腹痛，减轻不适感，其次<span style="color: black;">保准</span>视野清晰，降低病变漏检概率。注水<span style="color: black;">能够</span><span style="color: black;">显著</span>减轻腹痛程度，<span style="color: black;">尤其</span>是可降低便秘<span style="color: black;">病人</span><span style="color: black;">检测</span>过程中的<span style="color: black;">病痛</span>程度，<span style="color: black;">加强</span>满意率，<span style="color: black;">检测</span>过程辅助体位变化、腹部压迫概率<span style="color: black;">显著</span>降低，我<span style="color: black;">此刻</span><span style="color: black;">通常</span>是</span><span style="color: black;">2min</span><span style="color: black;">以内到末端回肠，初学者</span><span style="color: black;">10 min&nbsp;</span><span style="color: black;">内结肠镜到达末端回肠。</span></span></p>
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      <div style="color: black; text-align: left; margin-bottom: 10px;"> <a style="color: black;"> 视频详情 </a> </div>
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    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">注水法在消化内镜治疗中的应用</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">注水法内镜下粘膜切除术（</span>UEMR<span style="color: black;">）</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">Kenneth&nbsp;<span style="color: black;">等人</span><span style="color: black;">2011</span><span style="color: black;">年在加州太平洋医疗中心首次<span style="color: black;">报告</span>了</span><span style="color: black;">UEMR</span><span style="color: black;">。该<span style="color: black;">办法</span>仅将适量的水注入肠腔，并且<span style="color: black;">经过</span>水的浮力分离粘膜下层和固有肌层，而不注射粘膜下层。安全可行并且避免了针头转移的<span style="color: black;">危害</span>。</span><span style="color: black;">Kenneth</span><span style="color: black;">等人</span><span style="color: black;">"</span><span style="color: black;"><span style="color: black;">经过</span>&nbsp;</span><span style="color: black;">UEMR&nbsp;</span><span style="color: black;">成功切除了一组平均直径为</span><span style="color: black;">30</span><span style="color: black;">～</span><span style="color: black;">34 m</span></span><span style="color: black;">m</span><span style="color: black;"><span style="color: black;">的息肉。</span>Andre</span><span style="color: black;">w</span><span style="color: black;"><span style="color: black;">和其他<span style="color: black;">运用</span></span>UEMR&nbsp;<span style="color: black;">的<span style="color: black;">办法</span>成功切除了一组平均直径为</span><span style="color: black;">20m</span><span style="color: black;">的扁平病变。</span><span style="color: black;">UEMR</span><span style="color: black;"><span style="color: black;">能够</span>安全有效地治疗扁平病变和大息肉，<span style="color: black;">因为</span>水的特性，</span><span style="color: black;">UEMR</span><span style="color: black;"><span style="color: black;">拥有</span><span style="color: black;">必定</span>的<span style="color: black;">优良</span>。</span><span style="color: black;">UEMR&nbsp;</span><span style="color: black;">中<span style="color: black;">运用</span>的水<span style="color: black;">能够</span>吸收和传递热能，降低电切时息肉<span style="color: black;">周边</span>的跨壁灼伤<span style="color: black;">危害</span>。<span style="color: black;">同期</span>，</span><span style="color: black;">UEMR</span><span style="color: black;">不<span style="color: black;">必须</span>进行粘膜下注射，使操作更简单，有利于缩短整体手术时间。在对</span><span style="color: black;">UEMR&nbsp;</span><span style="color: black;">和&nbsp;</span><span style="color: black;">EMR</span><span style="color: black;">的回顾性<span style="color: black;">科研</span>中，</span><span style="color: black;">UEMR</span><span style="color: black;">组的手术时间为（</span><span style="color: black;">43.5±37.1</span><span style="color: black;">分钟），而</span><span style="color: black;">EMR</span><span style="color: black;">组的手术时间为（</span><span style="color: black;">54.3±38.1&nbsp;</span><span style="color: black;">分钟）（</span><span style="color: black;">P=0.37</span><span style="color: black;">）。显然，</span><span style="color: black;">UEMR</span><span style="color: black;">组的手术时间短于</span><span style="color: black;">EIR</span><span style="color: black;">组间。与传统的</span><span style="color: black;">EMR</span><span style="color: black;">相比，</span><span style="color: black;">UEMR</span><span style="color: black;">不<span style="color: black;">必须</span>连续向肠腔内注气，<span style="color: black;">亦</span>不会<span style="color: black;">导致</span>肠壁过度膨胀和变薄，从而减少穿孔的<span style="color: black;">出现</span>率。</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;">科研</span><span style="color: black;">显示</span>，</span>UEMR<span style="color: black;"><span style="color: black;">能够</span>完全切除中型息肉，降低复发率，延缓<span style="color: black;">流血</span>，降低透壁烧伤和穿孔的<span style="color: black;">出现</span>率。当在粘膜切除<span style="color: black;">时期</span><span style="color: black;">出现</span><span style="color: black;">流血</span>时，<span style="color: black;">能够</span>在水中清楚地<span style="color: black;">表示</span><span style="color: black;">流血</span>的<span style="color: black;">重点</span>部位，<span style="color: black;">因此呢</span>在内镜<span style="color: black;">检测</span>下<span style="color: black;">更易</span>快速准确地止血，这是一种安全，有效和可行的粘膜切除术。</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2</span><span style="color: black;">.</span><span style="color: black;"><span style="color: black;">经口内镜下注水法环形肌切开术（</span>U-POEM<span style="color: black;">）</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">Kenneth<span style="color: black;">等人<span style="color: black;">报告</span>了一种新的内镜环形肌切开术。<span style="color: black;">重点</span>是<span style="color: black;">经过</span>注水而不是胃灌洗来部分打开食道壁，并用水直接冲洗食道粘膜。浮力效应<span style="color: black;">增多</span>了粘膜下层与食道肌层之间的距离，而不<span style="color: black;">必须</span>粘膜下注射。<span style="color: black;">同期</span>，使粘膜剥高和止血更准确，避免<span style="color: black;">出现</span>皮下气肿。</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">3<span style="color: black;">注水法复位肠扭转</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">肠扭转<span style="color: black;">经过</span>内镜治疗<span style="color: black;">能够</span>避免部分手术并降低治疗<span style="color: black;">危害</span>，<span style="color: black;">尤其</span>是<span style="color: black;">针对</span>手术<span style="color: black;">危害</span>高的<span style="color: black;">病人</span>。然而，传统的注气内镜<span style="color: black;">检测</span><span style="color: black;">一般</span>会因过度扩张而扩张肠壁，<span style="color: black;">增多</span>穿孔的<span style="color: black;">危害</span>。</span>Sugimoto"<span style="color: black;">等<span style="color: black;">经过</span>注水肠镜<span style="color: black;">检测</span>成功复位了</span><span style="color: black;">21</span><span style="color: black;">例肠扭转<span style="color: black;">病人</span>，并且</span><span style="color: black;">1</span><span style="color: black;">例无并发症。<span style="color: black;">经过</span>在肠镜<span style="color: black;">检测</span>时注射水以减少肠道扭曲，无需<span style="color: black;">运用</span>镇静剂，当<span style="color: black;">病人</span>症状<span style="color: black;">显著</span>减轻时，说明复位成功。</span><span style="color: black;">Tan"</span><span style="color: black;">等还<span style="color: black;">报告</span>了</span><span style="color: black;">2</span><span style="color: black;">例用注水成功复位肠扭转的案例，并认为用注水肠镜<span style="color: black;">检测</span><span style="color: black;">能够</span>减少<span style="color: black;">危害</span>。注水的肠镜<span style="color: black;">检测</span>能够为操作者<span style="color: black;">供给</span>了良好的视野，即使是<span style="color: black;">无</span>进行肠道准备的<span style="color: black;">病人</span>。与注气<span style="color: black;">办法</span>相比，<span style="color: black;">运用</span>注水来复位肠扭转大大降低了<span style="color: black;">危害</span>。</span></span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">总之，注水法</span></span><span style="color: black;"><span style="color: black;">联合透明帽法</span></span><span style="color: black;"><span style="color: black;">已广泛用于内镜<span style="color: black;">检测</span>和治疗</span></span><span style="color: black;">,</span><span style="color: black;"><span style="color: black;">。在内镜<span style="color: black;">检测</span>方面，注水式结肠镜<span style="color: black;">检测</span><span style="color: black;">能够</span><span style="color: black;">明显</span>减轻<span style="color: black;">病人</span>的<span style="color: black;">病痛</span>。<span style="color: black;">尤其</span>适合老年人，有度部手术史，<span style="color: black;">长时间</span>便秘，可<span style="color: black;">加强</span>结肠镜<span style="color: black;">检测</span>的依从性。在内镜治疗中，注水法的最大优点是在传统的可充气结肠镜<span style="color: black;">检测</span>中避免粘膜下注射和肠壁过度扩张。相信随着<span style="color: black;">科研</span>的发展，在消化道内镜<span style="color: black;">检测</span>中的应用将进一步扩大，并将得到越来越多的医疗工作者的支持和认可。</span></span></p>
    <h1 style="color: black; text-align: left; margin-bottom: 10px;">注水肠镜<span style="color: black;">详细</span>操作过程如下：</h1>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1.带透明帽进镜；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2. 关闭注气按钮<span style="color: black;">亦</span><span style="color: black;">能够</span>不关闭，<span style="color: black;">经过</span>活检孔道注水（温水300-500ml）；基层医院<span style="color: black;">无</span>附送水的直接用注射器活检通道在直乙交界处注入就<span style="color: black;">能够</span>，10秒钟就<span style="color: black;">能够</span>完成，不会<span style="color: black;">增多</span>操作时间</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3. 寻腔进镜，注水暴露肠腔，进行进镜操作；<span style="color: black;">由于</span>水利用重力<span style="color: black;">功效</span>将乙状结肠和降结肠的袢打开，<span style="color: black;">因此呢</span>很少会有袢，<span style="color: black;">因此呢</span>大大降低了进镜难度，<span style="color: black;">病人</span><span style="color: black;">亦</span><span style="color: black;">无</span>不舒服的感觉。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">4. 因肠道准备<span style="color: black;">不良</span>时，进行注水冲洗清理肠道；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">5. 遇到肠腔存在空气时，吸出残余空气；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">6. 若进镜顺利，适当吸取多余水量，避免肠腔过度延伸；</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">7 退镜时，打开空气按钮，吸出残余肠腔液体并充分注气进行退镜检查或治疗。</p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">导致</span>结肠镜<span style="color: black;">插进</span>困难的<span style="color: black;">原由</span>如下:(病人<span style="color: black;">自己</span>的<span style="color: black;">原由</span>: <span style="color: black;">检测</span>医师的<span style="color: black;">原由</span>:③结肠镜的<span style="color: black;">原由</span>。到底是哪一种<span style="color: black;">原由</span><span style="color: black;">导致</span>的，<span style="color: black;">实质</span>操作中可能<span style="color: black;">常常</span>有多种<span style="color: black;">原因</span>存在。病人<span style="color: black;">自己</span><span style="color: black;">原因</span><span style="color: black;">包含</span>:①年龄(指小孩和高龄病人);②体型 (瘦弱、小个子、<span style="color: black;">肥壮</span>);3有手术史(妇科手术、胃肠道手术、多次手术);④有过腹膜炎病史;5结肠过长;6先天性结肠弯曲过大;⑦乙状结肠多发性憩室;8器质性<span style="color: black;">疾患</span>(结肠癌、炎症性肠病)<span style="color: black;">导致</span>的狭窄或炎症:9过度紧张;心其他严重心肺疾患等。高龄病人<span style="color: black;">常常</span><span style="color: black;">由于</span>心肺功能和肾功能低下，结肠壁<span style="color: black;">因为</span>老化使强度降低等<span style="color: black;">原由</span>容易<span style="color: black;">导致</span>穿孔等并发症<span style="color: black;">显现</span>。女性<span style="color: black;">因为</span>体型多为瘦弱目个子矮小，<span style="color: black;">另一</span>如驼背、有妇科手术史等， <span style="color: black;">常常</span><span style="color: black;">插进</span>闲难的病例比男性要多。乙状结肠多发性憩的病人，由肠壁固有肌层高度肥厚，使肠管狭窄等，即使是轻度伸展肠腔<span style="color: black;">亦</span>会<span style="color: black;">导致</span>病人<span style="color: black;">病痛</span>，<span style="color: black;">引起</span><span style="color: black;">没法</span>完成全结肠<span style="color: black;">检测</span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">医师方面的<span style="color: black;">原由</span>中<span style="color: black;">包含</span>:<span style="color: black;">检测</span>医师采用结肠镜<span style="color: black;">插进</span>法的原则(始终采用结肠短缩法;经常采用推进技术，延仲肠壁后再短缩等)、结肠插人的技术水平(最小限度注气的水准、体位改变和压迫的<span style="color: black;">机会</span>等)和<span style="color: black;">检测</span>医师的判断(<span style="color: black;">是不是</span>结襻的判断、<span style="color: black;">是不是</span>适时替换<span style="color: black;">检测</span>医师、<span style="color: black;">是不是</span>在清状态下采用镇静等)等。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">结肠镜方面的要因<span style="color: black;">包含</span>结肠镜的外径、硬度、长度等内镜构造上的问题。这一点在前面的章节已有<span style="color: black;">描述</span>。<span style="color: black;">针对</span>插人困难的病例，改变病人<span style="color: black;">自己</span><span style="color: black;">原因</span>是不太可能的， 结肠镜的<span style="color: black;">选取</span><span style="color: black;">常常</span><span style="color: black;">亦</span>很无奈。惟一<span style="color: black;">能够</span><span style="color: black;">加强</span>的是<span style="color: black;">检测</span>方面多下功夫。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">详细</span>的对策如下:1尽可能地少量注入温水，不要注气，采用短缩法的操作原则，<span style="color: black;">奋斗</span><span style="color: black;">加强</span>结肠镜<span style="color: black;">插进</span>水准;②<span style="color: black;">协同</span>好体位的改变和用手压迫法；3必要时放弃交给上级医师;4适时放弃结肠镜<span style="color: black;">检测</span>，改用钡剂灌肠<span style="color: black;">检测</span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">&nbsp;有过腹部手术的病人&nbsp;</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">腹部手术<span style="color: black;">引起</span>腹腔内粘连的产生，<span style="color: black;">导致</span>病人在<span style="color: black;">插进</span>过程中<span style="color: black;">显现</span><span style="color: black;">病痛</span>，<span style="color: black;">引起</span><span style="color: black;">插进</span><span style="color: black;">检测</span>失败的病例，在<span style="color: black;">平常</span>的工作中还是时有<span style="color: black;">出现</span>的。病例数不是<span style="color: black;">非常多</span>，<span style="color: black;">然则</span><span style="color: black;">都数</span>插人困难、操作失败，其至穿孔的病例较多<span style="color: black;">出现</span>于此类病人，操作时<span style="color: black;">必要</span>格外小心。严禁暴力的无理进镜。插人时碰到<span style="color: black;">很强</span>的抵抗力，<span style="color: black;">已然</span>感觉到了粘连时，过度用力插镜，必然是<span style="color: black;">引起</span>穿孔的<span style="color: black;">原由</span>。结肠镜毕竟不是肠道<span style="color: black;">检测</span>的惟一手段，<span style="color: black;">不消</span>过度冒险。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">有过腹部手术<span style="color: black;">导致</span>肠粘连时，应该<span style="color: black;">重视</span>以下几点:1要有良好的肠道准备:②<span style="color: black;">运用</span>解痉药;3<span style="color: black;">协同</span>体位改变和用手压迫法;④替换<span style="color: black;">检测</span>的医师:<span style="color: black;">即时</span>地终止结肠镜<span style="color: black;">检测</span>等。影响结肠镜<span style="color: black;">检测</span>的手术<span style="color: black;">能够</span>有妇科手术、结肠癌手术、胆囊手术、胃大部切除术等，<span style="color: black;">区别</span>手术<span style="color: black;">导致</span>粘连的部位<span style="color: black;">区别</span>，<span style="color: black;">导致</span>的肠镜<span style="color: black;">插进</span>时困难的<span style="color: black;">体积</span><span style="color: black;">亦</span>不<span style="color: black;">同样</span>，<span style="color: black;">检测</span>前<span style="color: black;">认识</span>病史，<span style="color: black;">针对</span>更好地完成<span style="color: black;">检测</span>有着很大的<span style="color: black;">功效</span>。以下是<span style="color: black;">各样</span>腹部手术的<span style="color: black;">实质</span>操作<span style="color: black;">状况</span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">&nbsp;妇科手术 是最<span style="color: black;">平常</span>的</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">能够</span>说是结肠镜<span style="color: black;">检测</span>中难度最高的，大<span style="color: black;">都数</span><span style="color: black;">状况</span>下<span style="color: black;">导致</span>&nbsp;</span><span style="color: black;">乙状结肠间的相互粘连，<span style="color: black;">乃至</span>小肠粘连。从 Stop处至乙状结肠的弯曲变得更大，有时还会<span style="color: black;">显现</span>非常<span style="color: black;">繁杂</span>的<span style="color: black;">状况</span>，操作时采用的结肠镜插人原则是不变的，在事先<span style="color: black;">认识</span>手术的<span style="color: black;">状况</span>下，更应该严格遵守短缩法的原则，小心<span style="color: black;">小心</span>，严禁暴力操作。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">小心<span style="color: black;">小心</span>的操作<span style="color: black;">包含</span>:1尽可能的少量注入温水，<span style="color: black;">不可</span>注气;②尽可能地采用短缩法;3精细地调节<span style="color: black;">方向</span>钮:严密<span style="color: black;">重视</span>病人的反应;④必要时不采用旋转加向上调节按钮，改为向下调节按钮，<span style="color: black;">调节</span>旋转镜身的<span style="color: black;">方向</span>;严密感受<span style="color: black;">有没有</span>结或阻力;⑥遇到结或阻力， 轻柔地解襻和退镜;<span style="color: black;">恰当</span>的多合压迫法等等。总之，在避免形成<span style="color: black;">很强</span>的时候，<span style="color: black;">都数</span><span style="color: black;">状况</span>还是能够在儿乎<span style="color: black;">无</span>痛苦的<span style="color: black;">状况</span>下，顺利完成操作的。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">结肠切除手术&nbsp;</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">大多<span style="color: black;">状况</span>下分为左半结肠和右半结肠切除手术两种。当行左半结肠手术后，<span style="color: black;">因为</span>切除了结肠内曲最多的部位，剩余的结肠变得较直，粘连<span style="color: black;">亦</span>很少<span style="color: black;">导致</span>较多弯曲，反而<span style="color: black;">因为</span>粘连和结肠变短，<span style="color: black;">不易</span>形成、操作时<span style="color: black;">常常</span>比较顺利。相反，当手术是切除右半结肠时，<span style="color: black;">状况</span>不问。虽然看似切除了半数的结肠，但<span style="color: black;">因为</span>S-top至乙状结肠部位<span style="color: black;">保存</span>，<span style="color: black;">倘若</span>加上粘连，有时会比较麻烦。<span style="color: black;">协同</span>必要的<span style="color: black;">选取</span>压迫部位是<span style="color: black;">必要</span>的。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">胃大部切除术和胆囊摘除术&nbsp;</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">一般</span>在横结肠部位与腹壁有粘连。从直肠到脾曲为止的操作，<span style="color: black;">常常</span>困难不大，有时会在通处横结肠脾曲和肝区处遇到不小的困难。<span style="color: black;">一样</span>在少注气、直线进入横结肠<span style="color: black;">针对</span>以后的操作<span style="color: black;">来讲</span>，是必不可少的。压迫脐处的压迫上点，其至除此之外，<span style="color: black;">协同</span>压迫脾曲和肝曲，<span style="color: black;">常常</span>能起到良好的效果，在病人无 <span style="color: black;">显著</span>痛苦的时候，往里<span style="color: black;">插进</span>饶身，即使稍稍起襻，有时<span style="color: black;">亦</span>可采用，总之，不管是病人有过什么样的腹部手术史，严格<span style="color: black;">根据</span>小心<span style="color: black;">小心</span>的操作原则，<span style="color: black;">必要</span>耐心地反复尝试<span style="color: black;">区别</span>手法，一旦<span style="color: black;">显现</span>用力病人<span style="color: black;">显现</span>痛苦，<span style="color: black;">即时</span>地变换手法，避免并发症的<span style="color: black;">显现</span>，必要时放弃<span style="color: black;">检测</span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">&nbsp; &nbsp; &nbsp;结肠过长的病人&nbsp;</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">结肠过长<span style="color: black;">常常</span>出<span style="color: black;">此刻</span>体型<span style="color: black;">肥壮</span>、瘦长、便秘的病人身上， <span style="color: black;">因此</span>在<span style="color: black;">检测</span>之前，应该对以上体型的病人<span style="color: black;">导致</span><span style="color: black;">注重</span>。当然，操作的基本原则是不变的。少注气、尽可能的短缩法的原是关键。<span style="color: black;">尤其</span>是在S-top至乙状结肠段，最好在一<span style="color: black;">起始</span>就<span style="color: black;">协同</span>压迫A点的<span style="color: black;">办法</span>，尽可能地避免有伸展肠腔的操作， 哪怕是极其轻微的<span style="color: black;">状况</span>，做到防患于未然。有些医师可能会认为<span style="color: black;">起始</span>即使稍微有所使肠腔伸展，或多放<span style="color: black;">有些</span>空气，只要以后<span style="color: black;">重视</span>吸气，短缩肠腔就<span style="color: black;">能够</span>了。要<span style="color: black;">晓得</span>，<span style="color: black;">倘若</span><span style="color: black;">已然</span><span style="color: black;">太多</span>注人空气或伸展肠腔，即使以后缩短肠腔，<span style="color: black;">亦</span>是达不到非常好的套叠肠段的目的。<span style="color: black;">由于</span>有了空气后，使套叠好的肠段之间会残留空气，使套叠的肠段不服帖，残留隐患，有时会<span style="color: black;">引起</span>某处“习惯性”的形成襻，给以后的操作带来很大的困难。<span style="color: black;">因此</span>在一<span style="color: black;">起始</span>就<span style="color: black;">必要</span>全力以赴，最好把主机上的空气按钮放在低的位置上进行操作。在<span style="color: black;">经过</span>乙状结肠位置时，<span style="color: black;">能够</span><span style="color: black;">经过</span>寻找最佳的压迫点，来<span style="color: black;">保准</span>结肠镜成直线由进镜。在<span style="color: black;">经过</span>升结肠、脾曲时，<span style="color: black;">亦</span><span style="color: black;">能够</span><span style="color: black;">经过</span>压迫脐上点，在<span style="color: black;">经过</span>横结肠时压迫脐右点，在<span style="color: black;">经过</span>肝区时压迫脐右点或<span style="color: black;">选取</span>最佳位点，联合压迫，<span style="color: black;">奋斗</span>做到短缩法进镜是最好的办法，<span style="color: black;">同期</span><span style="color: black;">协同</span>体位的改变，<span style="color: black;">办法</span><span style="color: black;">能够</span><span style="color: black;">根据</span><span style="color: black;">以上</span>，在<span style="color: black;">肥壮</span>病人时，有时<span style="color: black;">能够</span>采用俯卧位<span style="color: black;">做为</span>最后的手段。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">一旦<span style="color: black;">已然</span>延长了肠腔，以后的操作就变得困难许多，<span style="color: black;">常常</span>都是在横结肠内，怎么<span style="color: black;">亦</span><span style="color: black;">没法</span>再往前进镜，剩余的结肠镜刻度几乎没行。<span style="color: black;">倘若</span><span style="color: black;">协同</span>压迫和变换体位依然无效时，<span style="color: black;">能够</span>采用轻微向上调节旋钮保持不动，<span style="color: black;">而后</span>右旋镜身大于90度，<span style="color: black;">而后</span>吸完肠腔内的空气，<span style="color: black;">而后</span><span style="color: black;">逐步</span>退镜，直至感觉完全无襻后，再尝试进镜的<span style="color: black;">办法</span>，必要时退至肛门口重新<span style="color: black;">起始</span>，<span style="color: black;">亦</span>许效果不错. 结肠一旦伸展，内镜长度<span style="color: black;">不足</span>，以至于难以完成全结肠<span style="color: black;">检测</span>，在4级水平的肠镜医师身上是很少<span style="color: black;">出现</span>的。但旦<span style="color: black;">显现</span>比较难的时候，<span style="color: black;">需求</span><span style="color: black;">咱们</span><span style="color: black;">不可</span>有任何差错，做好思想准备，有时<span style="color: black;">乃至</span>于进2cm,退 1cm的操作都有可能，<span style="color: black;">必须</span>耐心<span style="color: black;">小心</span>地完成操作。在<span style="color: black;">实质</span>操作中越难的时候，采用向下调节旋钮<span style="color: black;">协同</span>吸气的场合就越多。必要时<span style="color: black;">能够</span>在<span style="color: black;">协同</span>压迫的<span style="color: black;">要求</span>下，采用<span style="color: black;">连续</span>往里送镜身，直至进入降结肠、横结肠、脾曲、升结肠、 肝曲这些固<span style="color: black;">选定</span>后，再<span style="color: black;">起始</span>短缩肠腔<span style="color: black;">亦</span>是无奈之举。<span style="color: black;">然则</span>在操作中<span style="color: black;">必要</span>严密观察病人<span style="color: black;">状况</span>及阻力<span style="color: black;">体积</span>，防止并发症的<span style="color: black;">显现</span>。必要时操作者应该得“放弃”，尽快地把<span style="color: black;">检测</span>交给上级医师，<span style="color: black;">或</span>改用其他<span style="color: black;">检测</span><span style="color: black;">办法</span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">高龄病人&nbsp;</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">通常</span><span style="color: black;">状况</span>下，高龄病人<span style="color: black;">指的是</span>80岁以上的病人。高龄者的肠管容易受到<span style="color: black;">损伤</span>，<span style="color: black;">流血</span>、穿孔等并发症<span style="color: black;">显现</span>的可能性<span style="color: black;">增多</span>， 绝对<span style="color: black;">不可</span>采用暴力来完成<span style="color: black;">检测</span>。<span style="color: black;">乃至</span>于带襻进都有可能<span style="color: black;">显现</span>并发症。<span style="color: black;">然则</span>随着社会的进步，即使是高龄身体健康者<span style="color: black;">亦</span>不在<span style="color: black;">少许</span>，<span style="color: black;">根据</span>常规的操作法进镜<span style="color: black;">一般</span>是<span style="color: black;">无</span>问题的。<span style="color: black;">通常</span><span style="color: black;">状况</span>下，<span style="color: black;">导致</span>高龄病人插人难度<span style="color: black;">增多</span>的<span style="color: black;">原由</span>如下: 1肠道准备<span style="color: black;">欠好</span>:②肠管之间粘连，<span style="color: black;">导致</span>肠段的可塑性降低; <span style="color: black;">针对</span>肠镜侵入的身体抵抗力降低等。随着年龄的<span style="color: black;">增多</span>，以上各<span style="color: black;">状况</span><span style="color: black;">出现</span>的可能性<span style="color: black;">增多</span>，在操作中应该<span style="color: black;">导致</span><span style="color: black;">注重</span>。</span></p>
    <p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">期盼</span><span style="color: black;">咱们</span><span style="color: black;">一直</span>的进步与学习，造福<span style="color: black;">更加多</span>的桑梓！</span><span style="color: black;"><span style="color: black;">这里</span>感谢八木一芳教授，麻兴华教授，后藤利夫教授，胃肠病老杜老师的<span style="color: black;">指点</span>与<span style="color: black;">帮忙</span>，友谊早癌团队，柳叶新潮团队，金木兰教授及医拓网团队，金珠教授（欢迎<span style="color: black;">大众</span>去参加金珠教授在壹生的病理训练营），一听大师，伏大，雨夜大师，黎叔，宫健师兄，大伟师兄们的<span style="color: black;">帮忙</span>与支持。<span style="color: black;">举荐</span><span style="color: black;">大众</span>去<span style="color: black;">她们</span>的公众号学习与听课，或联系宫大买书，精彩的课程请<span style="color: black;">大众</span>去戎龙教授镜道研习社一听大师的系列课程还有朵朵医云王宏光教授的早会直播间学习。</span></p>
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4lqedz 发表于 2024-10-4 14:03:25

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1fy07h 发表于 2024-10-25 12:56:05

期待楼主的下一次分享！”

查看完整版本: 注水肠镜合集以及技巧大全注意事项（包含视频及工藤教授的肠镜技巧及书籍）