Cirocco W C, Rusin L C
Department of Colon and Rectal Surgery, Saint Vincent Health Center/Hamot Medical Center, Erie, Pennsylvania, USA.
Dis Colon Rectum. 1995 Sep;38(9):964-8. doi: 10.1007/BF02049733.
Certain factors in a patient's history, such as prior abdominal surgery or complicated diverticular disease, have been reported to hinder cecal intubation during colonoscopy. Over a 16-month period, 1,047 consecutive colonoscopies were prospectively evaluated to determine whether these factors were indeed clinically relevant.
Of the 90 patients (9 percent) who had incomplete intubation of the colon, there were significantly more women (66 percent) than men (34 percent) (P < 0.001). Women with a history of abdominal hysterectomy had a significantly lower cecal intubation rate (P < 0.01). A history of diverticulitis did not alter the cecal intubation rate. In patients with incomplete colonic intubation, the most proximal extent of intubation was the sigmoid colon in women (31 percent) and the right colon in men (68 percent). Sixty-seven percent of patients with incomplete intubation of the colon had a prior colonoscopy completed to the cecum (67 percent women, 67 percent men), whereas 50 percent had a follow-up colonoscopy completed to the cecum (56 percent women, 40 percent men).
Women, especially those with a history of abdominal hysterectomy, had a significantly lower cecal intubation rate usually because of an impassable sigmoid colon. Prior inability to complete colonoscopy to the cecum does not necessarily forecast future failure.
据报道，患者病史中的某些因素，如既往腹部手术史或复杂性憩室病，会妨碍结肠镜检查时的盲肠插管。在16个月的时间里，对1047例连续进行的结肠镜检查进行了前瞻性评估，以确定这些因素是否确实具有临床相关性。
在90例（9%）结肠镜检查未完成全结肠插管的患者中，女性（66%）明显多于男性（34%）（P<0.001）。有腹部子宫切除术史的女性盲肠插管率明显较低（P<0.01）。憩室炎病史并未改变盲肠插管率。在结肠镜插管未完成的患者中，女性插管最接近的部位是乙状结肠（31%），男性是右半结肠（68%）。67%的结肠镜检查未完成全结肠插管的患者既往结肠镜检查曾到达盲肠（女性67%，男性67%），而50%的患者后续结肠镜检查到达了盲肠（女性56%，男性40%）。
女性，尤其是有腹部子宫切除术史的女性，盲肠插管率明显较低，通常是因为乙状结肠无法通过。既往无法完成结肠镜检查到达盲肠并不一定预示未来会失败。
