2018 年第 3 期 第 13 卷

二甲硅油内镜下直接喷洒法与口服法在透明帽辅助结肠息肉切除术中的应用价值比较

Application of direct spraying and oral methods of simethicone during endoscopic transparent plastic cap-assisted colonic polypectomy

作者：尤嘉璐高峰张杰

英文作者：

单位：100029首都医科大学附属北京安贞医院消化内科

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• 摘要：

• 目的    比较二甲硅油内镜下直接喷洒法与口服法在透明帽辅助结肠息肉切除术中对结肠息肉检出数目和结肠气泡分级的影响。方法    入选2017年6—11月于首都医科大学附属北京安贞医院消化内科门诊行透明帽辅助结肠镜检查发现结肠息肉并入院行内镜下息肉电切术患者120例，将患者完全随机分为口服组、喷洒组及联合组，各40例。所有患者门诊初次行透明帽辅助结肠镜检查前6 h和入院后结肠镜复查前6 h口服复方聚乙二醇电解质散剂，口服组于聚乙二醇电解质散清洁肠道后口服二甲硅油乳剂20 ml，喷洒组于肠镜检查退镜过程中根据肠道气泡情况按需喷洒二甲硅油乳剂20 ml，联合组于聚乙二醇电解质散清洁肠道后口服二甲硅油乳剂20 ml，并于肠镜检查退镜过程中根据肠道气泡情况按需再喷洒二甲硅油乳剂20 ml。比较3组患者门诊初次结肠镜检查及住院使用二甲硅油后复查过程中结肠息肉检出数目及结肠气泡分级的差异。结果    口服组、喷洒组、联合组入院使用二甲硅油后结肠镜复查结肠息肉检出数目均高于门诊初次检查时［3（2，4）枚比2（1，3）枚，4（3，5）枚比3（2，4）枚，4（2，5）枚比2（1，4）枚］，结肠气泡分级均低于初次检查时［1（1，2）级比2（2，3）级，1（1，1）级比2（2，3）级，1（1，1）级比2（2，3）级］，差异均有统计学意义（均P＜0.05）。使用二甲硅油后，喷洒组和联合组结肠息肉检出增加数目和结肠气泡分级改善情况均明显优于口服组［1（0，1）、1（0，1）枚比0（0，1）枚；1（1，2）、1（0，2）级比1（0，1）级］，差异均有统计学意义（均P＜0.05），而喷洒组和联合组间差异均无统计学意义（均P＞0.05）。结论    二甲硅油内镜下直接喷洒法简便易行，且能够增加结肠息肉检出数目，减少肠道气泡，效果优于口服法。

• Objective    To investigate the effects of direct spraying and oral Methods     of simethicone on detection number of colonic polyps and classification of colonic bubbles during endoscopic transparent plastic cap-assisted colonic polypectomy. Methods    Totally 120 patients who were diagnosed of colonic polyps by transparent plastic cap-assisted colonoscopy at outpatient department of gastroenterology from June to November 2017 in Beijing Anzhen Hospital, Capital Medical University were enrolled, and they were randomly divided into oral group, spraying group and combination group, with 40 patients in each group. All patients had reexamination of colonoscopy after admission. All groups took compound polyethylene glycol electrolyte powder 6 h before colonoscopy; the oral group took 20 ml simethicone emulsion after administration of polyethylene glycol; the spraying group had 20 ml simethicone emulsion during the withdrawing process of colonoscopy according to the condition of colonic bubbles; the combination group were treated by both of the oral and spraying Methods    . Detection number of colonic polyps and colonic bubble classification were analyzed. Results    Detection numbers of colon polyps of reexamination of colonoscopy were significantly more than those of the first examination in all groups［3（2，4） vs 2（1，3）， 4（3，5） vs 3（2，4）， 4（2，5） vs 2（1，4）］; colonic bubble classifications of reexamination were significantly lower than those of the first examination［1（1，2） vs 2（2，3）， 1（1，1） vs 2（2，3）， 1（1，1） vs 2（2，3）］（P＜0.05）. With application of simethicone, rise in the detection number of colonic polyps was significantly more and change of colonic bubble classification in spraying group was significantly better than those in oral group［1（0，1）, 1（0，1） vs 0（0，1）； 1（1，2）, 1（0，2） vs 1（0，1）］（P＜0.05）; there were no significant differences between spraying group and combination group（P＞0.05）. Conclusion    Direct spraying of simethicone during colonoscopy can help to reduce colonic bubbles and detect more polyps.