结肠镜标准化插入流程的循证基础与培训转化

Evidence-Based Foundations and Training Implementation of Standardized Colonoscope Insertion Protocols

摘要: 结肠镜插入质量直接影响盲肠到达、患者耐受性及撤镜观察条件，是结肠镜质量控制的重要基础。本文围绕结肠镜标准化插入流程，综述轴保持与短缩、水辅助插入、少气/吸引、腹压与体位调整、透明帽辅助及困难插镜处理等策略的循证依据，并分析其在流程构建、质量评价和培训转化中的应用价值。现有证据显示，多项单一技术可在特定场景下改善插入效率、疼痛体验或辅助操作需求，但研究多受病例选择、操作者经验、技术定义和评价终点差异影响，尚不足以证明某一完整标准化流程的普遍有效性。标准化流程的主要价值在于将分散经验转化为可执行、可评价且可推广的操作路径。未来仍需开展多中心真实世界研究，进一步明确流程构成、评价指标及培训转化效果。

Abstract: The quality of colonoscope insertion directly influences cecal intubation, patient tolerability, and subsequent withdrawal-phase mucosal inspection, and is therefore a key component of colonoscopy quality control. This review summarizes the evidence for major insertion optimization strategies, including axis maintenance and loop reduction, water-assisted insertion, luminal management through minimal insufflation and suction, abdominal compression, patient repositioning, cap-assisted insertion, and management of difficult colonoscopy. It further discusses the rationale for developing a standardized insertion protocol and its value in quality assessment and training implementation. Current evidence indicates that individual techniques may improve insertion efficiency and patient comfort, or reduce the need for auxiliary maneuvers in selected settings. However, heterogeneity in case selection, operator experience, technical definitions, and outcome measures limits direct extrapolation to the overall effectiveness of a complete standardized protocol. The primary value of a standardized protocol lies in consolidating scattered experience-based skills into an executable, assessable, and generalizable structured pathway. Further multicenter real-world studies are needed to define its components, evaluation metrics, and training outcomes.