Ryan C K, Potter G D
J Clin Gastroenterol. 1995 Jul;21(1):6-9. doi: 10.1097/00004836-199507000-00002.
Commercially available endoscope disinfecting solutions readily cause colonic damage if allowed to contact mucosa. The two most common cleaning solutions differ in their initial toxic effect (glutaraldehyde directly injuries crypt epithelium, and hydrogen peroxide compromises mucosal stroma), but both ultimately result in tissue necrosis over time. Within 12-48 h after colonoscopy, patients show signs of bloody diarrhea, cramping, and fever--symptoms that may be confused with an infectious process. Based on a literature review and our own experimental studies, we conclude that hydrogen peroxide alone is responsible for a unique form of colitis commonly referred to as pseudolipomatosis by pathologists. This controversial lesion becomes visible as opaque plaques or pseudomembranes even while colonoscopy is in progress and is almost assuredly due to the effervescent release of molecular oxygen. Diligent rinsing is necessary to minimize patients' exposure to residual disinfecting chemicals in the endoscope. When an automatic disinfecting machine is employed, it may require strict adherence to proper maintenance and volume adjustments in the rinse cycle. Forced air drying and an additional preprocedure rinse of channels and the exterior of the scope should ensure a chemical-free examination.
市售的内镜消毒溶液如果接触到黏膜，很容易造成结肠损伤。两种最常用的清洁溶液在初始毒性作用方面有所不同（戊二醛直接损伤隐窝上皮，过氧化氢损害黏膜基质），但随着时间的推移，两者最终都会导致组织坏死。在结肠镜检查后12至48小时内，患者会出现血性腹泻、绞痛和发热等症状，这些症状可能会与感染过程相混淆。基于文献综述和我们自己的实验研究，我们得出结论，单独使用过氧化氢会导致一种独特形式的结肠炎，病理学家通常称之为假脂肪瘤病。即使在结肠镜检查过程中，这种有争议的病变也会表现为不透明的斑块或假膜，几乎可以肯定是由于分子氧的泡腾释放所致。必须进行彻底冲洗，以尽量减少患者接触内镜中残留的消毒化学物质。当使用自动消毒机时，在冲洗周期中可能需要严格遵守正确的维护和体积调整要求。强制空气干燥以及在操作前对通道和内镜外部进行额外冲洗，应能确保检查时无化学物质残留。
