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长期的临床工作中，我们发现结肠憩室病并非是我们以往认为少见疾病，随着对疾病认识的加深和人口老龄化，憩室病会越来越多的进入我们外科医生的视线，为了全面了解这种疾病，更好地服务病人，我们将为科室同事解读国际权威机构指南。部分内容在此平台分享。不妥之处敬请指正！ 鸣谢：资料整理过程中暨南大学附属华侨医院胃肠减重代谢外科董志勇博士和华北医疗峰峰集团总医院邯郸院区普外科王鹏主治医师帮助、校对。在此对他们提出的建设性意见表示衷心的感谢！ CQ11:Is bowel preparation with an oral lavage solution effective for colonoscopy for acute LGIB and colonic diverticular bleeding? CQ11:对于急性下消化道出血和结肠憩室出血病人口服灌洗液体肠道准备是否有效？ Statement: Bowel preparation with an oral lavage solution is recommended, except for patients with contraindications. 声明:除了病人存在禁忌症，指南推荐口服肠道灌洗液进行肠道准备。 Qualityof evidence: C 证据级别：C Strengthof recommendation: Doit Agreement rate: 100% 推荐强度：100% Explanation The purpose of colonoscopy in patients with acute LGIB and colonic diverticular bleeding is to provide accurate diagnosis and proper treatment. 急性下消化道出血和结肠憩室出血病人结肠镜检查的目的是提供准确的诊断和正确的治疗。 For this, bowel preparation is important to ensure the safety of colonoscopy and a high success rate of reaching the cecum. The frequencies of unexpected adverse events attributable to oral lavage agents do not differ significantly between acute LGIB and non-GI bleeding , and bowel preparation has been shown to facilitate the accurate diagnosis of disease and SRH (SRH) and enable endoscopic treatment . 为此，肠道准备对于确保肠镜安全实施和较高成功率的到达盲肠部位至关重要，口服灌洗制剂导致的意外不良事件发生频率在急性下消化道出血和非胃肠道出血性疾病之间没有明显差异，已研究证明肠道准备可以促进疾病和具有近期出血特征病人的准确诊断，因此使内镜治疗成为可能。 On the other hand, the rate of reaching the cecum was not high,in therange of 20–70%, among patients who had colonoscopy in the early phase without bowel preparation with oral lavage solution , and 6.4% of the patients(22/345)developed fever after colonoscopy . 另一方面，在早期阶段，如果没有口服灌洗液肠道准备的结肠镜检查到达盲肠的比例不高，一般在20–70%范围内,有6.4%的病人肠镜检查会发烧(22/345)。 Two retrospective observational studies have investigated the difference in cecal intubation rates between bowel preparation with oral lavage solutions and other bowel preparation methods (e.g., enema) and reported a higher rate with the former . 两个回顾性观察性研究调查了口服灌洗液结肠镜检查组和其他肠道准备组（包灌肠组）肠镜到达盲肠的区别，发现前者有明显高的成功率。 Use of other bowel preparation methods (without using oral lavage solutions) is acceptable and bowel preparation itself can be eliminated in patients with post-polypectomy bleeding or rectal ulcer in which bleeding sources can be anticipated before colonoscopy. Otherwise, bowel preparation with oral lavage solutions is recommended. 应用其他的肠道准备方法（不用灌洗液）是可以接受的，结肠镜息肉切除手术后出血的病人和结肠镜检查前出血来源可以预期的直肠溃疡病人肠道准备可以省略，否则，则推荐使用口服灌洗液的肠道准备方法。 CQ12:Is total colonoscopy effective for acute LGIB and colonic diverticular bleeding? 急性下消化道出血和结肠憩室出血病人全结肠镜检是否有效？ Statement: Colonic diverticular bleeding is the leading cause of acute LGIB. Therefore, it is recommended that total colonoscopy covering the terminal ileum be performed. 声明：结肠憩室出血是急性下消化道出血的首要原因。因此，指南推荐应用到达盲肠的全结肠镜检查。 Qualityof evidence: C 证据级别：C Strength ofrecommendation: Do it Agreementrate: 100% 推荐强度：100% Explanation No previous studies have compared sigmoidoscopy and total colonoscopy in diagnostic and endoscopic therapy for acute LGIB or colonic diverticular bleeding. 目前尚未发现乙状结肠镜检查和全结肠镜检查在诊断和治疗急性下消化道出血和憩室出血对比的研究报告。 Colonic diverticular bleeding is the leading cause of acute LGIB . In patients with colonic diverticular bleeding, diverticula with SRH (seeCQ13)are often detected on the right side of the colon , and although rare,hemorrhagic lesions are observed in the terminal ileum from time to time . 结肠憩室出血是急性下消化道出血的首要原因。在结肠憩室出血的病人中，憩室伴随有近期出血特征经常见于右侧结肠。这种情况尽管少见，出血部位经常在末端盲肠发现。 Therefore, we recommend total colonoscopy encompassing the terminal ileum.Acute rectal ulcer, ischemic enteritis, and tumors are also included in clinical cases of acute LGIB . But these do not necessarily require total colonoscopy in emergency situations. 因此，我们推荐包括末端盲肠在内的全结肠镜检查。急性直肠溃疡、缺血性肠炎和肿瘤也在急性下消化道出血的临床病例之中。但是这种情况在急诊情况下并不要求全结肠镜检查。 CQ13: What endoscopic findings of colonic diverticular bleeding are indications for endoscopic hemostasis? 什么征象是结肠憩室出血内镜治疗的指正？ Statement: The following are defined as SRH: (i) active bleeding;(ii) non-bleeding visible vessels; and (iii) adherent clot underlying (i) or (ii). Endoscopic hemostasis is recommended for a colonic diverticulum with SRH. 声明：下列发现被定义为近期出血性特征stigmata of recent hemorrhage (SRH) (i)活动性出血 (ii)没有出血的可见的裸露血管；(iii)(i) or (ii)下面粘附血块。指南推荐具有近期出血性特征结肠憩室接受内镜下止血。 Quality of evidence: C 证据级别：C Strength of recommendation: Do it Agreement rate: 100% 推荐强度：100% Explanation Active bleeding (Fig. 3a),non-bleeding visible vessels (Fig. 3b), and adherent clots (Fig. 3c, d) that develop into active bleeding or non-bleeding visible vessels upon removal of clots are defined as SRH .Definitive colonic diverticular bleeding is defined as colonoscopic visualization of colonic diverticulum with SRH. 我们把活动性出血、裸露血管的非活动性出血、可以发展成活动性出血或者移除血块后非活动性出血的裸露血管这几种情况定义为近期出血性特征stigmata of recent hemorrhage (SRH) Presumptive diagnosis is based on fresh blood localized to colonic diverticula in the presence of a potential bleeding source on complete colonoscopy; or bright red blood per rectum confirmed by colonoscopy that demonstrates a single potential bleeding source in the colon, complemented by negative upper endoscopy or negative capsule endoscopy, or negative nasogastric tube. 鉴定诊断基于下列情况确定诊断：全结肠镜检查时，存在可能位于潜在出血来源的结肠憩室的新鲜出血、结肠镜确定的经直肠的新鲜出血，并且经阴性的上消化道内镜、阴性胶囊内镜和阴性的鼻胃管证实的单一的潜在出血来源。 Previous cohort studies of patients with definitive diverticular bleeding have shown a high rate (53–66%) of early rebleeding (≤30 days of treatment) in patients who underwent conservative therapy alone, but the rate decreased with endoscopic hemostasis. 既往有确定性憩室出血病人的队列研究表明，单纯接受保守治疗的病人具有较高的早期(治疗30天内)在出血率(53–66%)。 Also, in a prospective cohort study , early rebleeding (≤30 days) did not occur after conservative treatment without endoscopic hemostasis in patients with black or dark red flat spots in colonic diverticula that did not appear to be visible vessels or in patients whose colonic diverticula were clean when clots were removed. 同样，在一个前瞻性队列研究中，结肠镜检查时，没有用内镜止血的保守治疗的病人，未发生早期再出血(≤30 days) ，这些病人在结肠镜检查时可以发现在憩室部位有黑色或暗红色扁平污点，而未发现裸露的血管。另外一部分未发生早期再出血的病人中，结肠镜检查时清除血凝块后，结肠憩室部位是清洁的。 Based on these findings, endoscopic hemostasis is recommended for colonic diverticula with SRH such as active bleeding, non-bleeding visible vessels, and adherent clots. 基于这些发现，对于存在SRH的结肠憩室病人，比如活动性出血、非出血的可见到裸露血管的和有粘附着血块的病人推荐内镜止血。 近期文献解读活动预告： 继续解读日本国大肠憩室病指南下列内容 一 CQ14: Are there any innovative and effective endoscopic tools for identifying the sourceof bleeding in acute LGIB and colonic diverticular bleeding? 在诊确定性下消化道出血和结肠憩室出血来源方面有哪些创新和有效地内镜工具？ 二 CQ15: What hemostatic methods are available for endoscopy? Is there any difference in effectiveness among them? 有哪些结肠镜下止血方法可供选择？它们之间效果上有什么不同？ 三 解读罗马尼亚Dr.Gérard Pavy, Pole Chirurgie Arras les Bonnettes,医生的关于他们做GERD手术的操作方法：A MODIFIED NISSEN - TOUPETPROCEDURE FOR THE TREATMENT OF GASTRO-ESOPHAGEAL REFLUX DISEASE AND HIATALHERNIA: HOW I DO IT |
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