Colonoscopy with the variable stiffness colonoscope.
Colonoscopy with the variable stiffness colonoscope.
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使用可变硬度结肠镜进行结肠镜检查。
DOI：
10.1067/s0016-5107(03)01873-x
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发表时间：
2003
影响因子：
7.7
通讯作者：
G. Ginsberg
中科院分区：
文献类型：
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作者：
G. Ginsberg
在结肠镜检查时，肠的尖锐角度和固定增加了手术的难度。肠的过度“环”意味着插入镜的力被转移到结肠壁或肠系膜附着处，而不是转移到结肠镜前端的向前推进。更硬的、大口径的、标准的成人结肠镜被认为能更好地允许“环减少”和持续的“矫直”。这一特征可称为柱强度。当近端被推时，柱强度防止仪器屈曲，并在将范围拉回以去除环时传递弹性以促进和保持矫直。然而，大口径瞄准镜可能不太能够穿越尖锐成角和狭窄的段。软性（非刚性）、小口径镜，如儿童结肠镜和推式肠镜，可能比标准成人结肠镜更好地穿过过度成角的结肠然而，小口径镜的过度灵活性不太容易使肠袢复位和持续的肠直。此外，小口径瞄准镜还具有较小的吸入/辅助通道，这可能阻碍残留粪便物质的清除，并对设备的使用造成限制。插入管的机械特性可能是决定结肠镜检查速度、舒适度和效率的最重要的仪器相关变量。理想情况下，结肠镜医生希望插入管高度灵活，但具有高柱强度。可变刚度结肠镜（VSC） （Olympus America Corp., Melville， N.Y.）是一种改进的结肠镜，配备了一种机制，使操作者能够调整仪器插入管的相对灵活性或刚度。可变刚度组件可以选择性地将小口径镜的灵活性与标准结肠镜的刚度结合起来。用于常规诊断和治疗用途，VSC是为了提高结肠镜检查的性能而开发的。
During colonoscopy, sharp angulations and fixation of the bowel increase the difficulty of the procedure. Excessive “looping” of the bowel implies that the force of scope insertion is transferred to the colon wall or to its mesenteric attachment instead of to the forward advancement of the leading tip of the colonoscope. Stiffer, large-caliber, standard adult colonoscopes are thought to better allow for “loop reduction” and sustained “straightening.” This feature may be referred to as column strength. Column strength prevents the instrument from buckling when the proximal end is being pushed and conveys elasticity to promote and maintain straightening when the scope is pulled back to remove loops. However, large-caliber scopes may be less capable of traversing sharply angulated and narrowed segments. Floppy (non-rigid), small-caliber scopes, such as pediatric colonoscopes and push enteroscopes, may better traverse excessively angulated sections of colon than standard adult colonoscopes.1,2 However, the exaggerated flexibility of small caliber scopes less readily enables loop reduction and sustained straightening of the bowel. Further, smallcaliber scopes also have a smaller suction/accessory channel that may impede clearance of residual fecal material and poses limitations on device use. The mechanical characteristics of the insertion tube may be the most substantial instrumentrelated variable in determining speed, comfort, and efficiency of colonoscopy. Ideally, colonoscopists want an insertion tube that is highly flexible yet has high column strength. The variable stiffness colonoscope (VSC) (Olympus America Corp., Melville, N.Y.) is a modified colonoscope equipped with a mechanism enabling the operator to adjust the relative flexibility or stiffness of the instrument’s insertion tube. The variable stiffness component may then selectively combine the flexibility of a small-caliber scope with the stiffness of a standard colonoscope. Intended for routine diagnostic and therapeutic use, the VSC was developed to enhance the performance of colonoscopy.