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结肠镜检查后大小便失禁----一种无法识别但可预防的疾病一项来自Gastronet质量保证计划的横断

发布日期:2014-1-29 12:40:31 文章来源:Endoscopy 作者次数:1417
    结肠镜检查后大小便失禁----一种无法识别但可预防的疾病。一项来自Gastronet质量保证计划的横断面研究

    G. Hoff1, 2, 3, V. Moritz1, M. Bretthauer2, L. Aabakken4, I. P. Berset5, T. Glomsaker6, O. Høie7, T. de Lange8, on behalf of the Gastronet collaborators

    1挪威希恩(3710)泰勒马克医院医学部

    2挪威奥斯陆(0304)挪威癌症登记处

    3挪威奥斯陆(0027) 奥斯陆大学

    4挪威奥斯陆0027奥斯陆大学医学系

    5挪威奥勒松6022奥勒松医院医学部

    6挪威斯塔万格(4068)斯塔万格大学医院外科

    7挪威阿伦达尔(4809Sørlandet医院医学部

    8挪威Rud1309Bærum医院Vestre Viken HF医学部

    背景:结肠镜检查要求吹入气体,以此达到肠壁的可视化。全球范围内通常吹入的是空气。本研究的目的是评估结肠镜检查术后大小便失禁发生的风险,并探讨以二氧化碳代替空气吹入是否可降低这种风险,此举措的原因是二氧化碳易于通过肠黏膜而被吸收。

    方法:这是一项对接受肠注入空气或二氧化碳的患者行结肠镜检查的多中心前瞻性研究。20091月至12月期间21所具有不同注入气体措施的内镜检查中心向挪威国家质量保证计划报道了一系列连续结肠镜检查术。本研究包括7812例接受门诊结肠镜检查的患者(≥18岁)。其中,5015例接受以空气注入方式行结肠镜检查2797例接受以二氧化碳注入行结肠镜检查

    结果:对于注入所用气体类型,采用二元逻辑回归分析比较结肠镜检查后24小时被报道大小便失禁的患者。对于年龄、性别、结肠镜检查适应症和镇静措施,空气组与二氧化碳组是相当的。据报道7812例患者中336例(4.3%)发生大小便失禁。二氧化碳组大小便失禁发生频率显著低于空气组[2.1%55%校正后的比值比(OR)为0.3895%置信区间为0.28-0.50P < 0.001]。女性患者发生大小便失禁的风险较男性患者高(校正后的OR1.7795%置信区间为1.39-2.24P < 0.001)。

    结论:约每20例接受采用标准空气注入的患者在检查后会出现大小便失禁。通过将空气注入改为易吸收的二氧化碳注入,这一比例可降低60%

     

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    Incontinence after colonoscopy - an unrecognized and preventable problem. A cross-sectional study from the Gastronet quality assurance program

    G. Hoff1, 2, 3, V. Moritz1, M. Bretthauer2, L. Aabakken4, I. P. Berset5, T. Glomsaker6, O. Høie7, T. de Lange8, on behalf of the Gastronet collaborators

    1Department of Medicine, Telemark Hospital, 3710 Skien,Norway

    2Cancer Registry ofNorway, 0304Oslo,Norway

    3University ofOslo, 0027Oslo,Norway

    4Department of Medicine, Rikshospitalet,UniversityofOslo, 0027Oslo,Norway

    5Department of Medicine,AalesundHospital, 6022 Aalesund,Norway

    6Department of Surgery,StavangerUniversityHospital, 4068Stavanger,Norway

    7Department of Medicine, Sørlandet HospitalArendal, 4809Arendal,Norway

    8Department of Medicine, Bærum HospitalVestre Viken HF, 1309 Rud,Norway

    Background: Colonoscopy requires insufflation of gas for visualization of the bowel wall. Worldwide, this is usually done using air. The aim of the present study was to assess the risk of postcolonoscopy incontinence, and to investigate whether insufflation of CO2 instead of air may reduce this risk, since it is easily absorbed through the bowel mucosa.

    Methods: This is a prospective multicenter study of colonoscopy patients undergoing bowel insufflation using air or CO2. A successive series of colonoscopies were reported to a national quality assurance program inNorwaybetween January and December 2009 from 21 endoscopy centers with varying insufflation practices. The study comprised 7812 patients aged 18 years or older who were referred for outpatient colonoscopy. Of these, 5015 underwent colonoscopy performed using air and 2797 colonoscopy using CO2 insufflation.

    Results: Patient-reported incontinence up to 24 h after colonoscopy was compared using binary logistic regression analysis for the type of gas used for insufflation. The air and CO2 patient groups were comparable with regard to age, sex, indication for colonoscopy, and sedation practice. Incontinence was reported by 336 out of 7812 patients (4.3 %). Incontinence was significantly less frequent in the CO2 group than in the air group [2.1 % versus 5.5 %; adjusted odds ratio (OR) 0.38; 95 %CI 0.28 - 0.50; P < 0.001]. Female patients had a higher risk of incontinence than men (adjusted OR 1.77; 95 % CI 1.39 - 2.24; P < 0.001).

    Conclusion: About every 20th patient undergoing colonoscopy using standard air insufflation experiences postexamination incontinence. This proportion can be reduced by 60 % by converting from air insufflation to insufflation with the absorbable CO2.

     

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