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目的:探讨无痛胃镜检查引起食管入口下部损伤率、原因及减少损伤的有效方法。方法 :6 040例行胃镜检查者根据操作方法不同分为3组:普通胃镜操作组(普通胃镜组2 862例)、无痛胃镜常规方法操作组(无痛常规组1 614例)、无痛胃镜改进方法操作组(无痛改进组1 564例)。统计每组食管入口下部的损伤率并进行差异性分析。结果:食管入口下部共发生损伤204例,损伤率3.4%(204/6 040)。损伤程度可分为轻度损伤和显著损伤。普通胃镜组损伤率4.1%(117/2 862),其中轻度损伤率3.1%(88/2 862),显著损伤率1.0%(29/2 862);无痛常规组损伤率3.7%(59/1 614),轻度损伤率2.8%(45/1 614),显著损伤率0.9%(14/1 614);无痛改进组损伤率1.8%(28/1 564),轻度损伤率1.6%(25/1 564),显著损伤率0.2%(3/1 564)。无痛改进组损伤率、显著损伤率均低于普通胃镜组、无痛常规组,差异有统计学意义(P<0.01)。结论:无痛胃镜检查可引起食管入口下部损伤,其中常规方法操作的损伤率与普通胃镜比较差异无统计学意义,应引起关注。通过一些操作方法的改进,可降低无痛胃镜检查引发食管损伤特别是显著损伤的风险,值得在临床上推广应用。
Objective: To investigate the lower rate of esophageal injury caused by painless gastroscopy, its causes and the effective methods to reduce the damage. Methods: 6 040 routine gastroscopy were divided into 3 groups according to different operation methods: general gastroscope operation group (2 862 cases of common gastroscopy group), conventional operation method group of painless gastroscopy (1 614 cases of no pain routine group), no pain Gastroscopy improved method of operation group (painless improvement group 1 564 cases). The damage rates of the lower esophagus in each group were statistically analyzed. Results: In the lower part of esophagus, there were 204 cases with injury rate of 3.4% (204/6 040). The degree of injury can be divided into mild injury and significant injury. The common injury rate was 4.1% (117/2 862) in the gastroscope group, with a slight injury rate of 3.1% (88/2 862) and a significant injury rate of 1.0% (29/2 862) / 1 614), mild injury rate 2.8% (45/1 614), significant injury rate 0.9% (14/1 614), painless improvement group injury rate 1.8% (28/1 564), mild injury rate 1.6 % (25/1 564), a significant injury rate of 0.2% (3/1 564). Painless improvement group injury rate, significant damage rate were lower than ordinary gastroscopy group, painless conventional group, the difference was statistically significant (P <0.01). Conclusion: Painless gastroscopy can cause lower esophageal injury, in which the damage rate of conventional method operation is not statistically significant compared with conventional gastroscopy, which should be paid attention to. The improvement of some operation methods can reduce the risk of esophageal injury induced by painless gastroscopy, especially significant damage, which is worth popularizing in clinic.