双语学习分享内镜标准进镜与定位观察学习笔记
- 2026-11-09 09:03:38
双语学习分享内镜标准进镜与定位观察学习笔记做胃镜，不只是把镜子送进去，规范的进镜路线、准确的方位识别，是不漏诊、不误判病变的基础。熟练掌握各腔壁方位标识，我们才能精准描述病灶位置、规范留存内镜图像。 When performing gastroscopy, it is not simply inserting the endoscope. Standard intubation routes and accurate orientation recognition are the basis for avoiding missed diagnosis and misjudgment of lesions. By mastering the wall markers of each lumen, we can accurately describe lesion locations and standardize endoscopic image storage. 1. 食管：分为前壁、后壁、左壁、右壁，以内镜视野做参照，四个象限划分，方便标记病灶。 Esophagus: Divided into anterior wall, posterior wall, left wall and right wall based on the endoscopic visual field with four quadrants for lesion marking. 
2. 胃体部：四壁分别为前壁、后壁、大弯、小弯；胃体小弯有标志性小弯线，是非常重要的定位参照。 Gastric body: Four walls include anterior wall, posterior wall, greater curvature and lesser curvature. The lesser curvature line of gastric body is an important landmark for localization. 
3. 十二指肠球部：标识有前壁、后壁、小弯、大弯，标志性结构为十二指肠上角，是球部通往降部的分界。 Duodenal bulb: Marked with anterior wall, posterior wall, lesser curvature and greater curvature. The superior duodenal angle is the boundary between bulb and descending part. 
4. 十二指肠降部：标志性结构为Vater乳头，是识别降部的核心标志。 Duodenal descending part: The landmark structure is the Vater papilla, the core marker to identify the descending part. 
进镜整体顺序：食管 → 胃腔（胃底、胃体）→ 胃窦 → 十二指肠球部 → 十二指肠降部。 The general intubation sequence: Esophagus → Gastric cavity (gastric fundus, gastric body) → Gastric antrum → Duodenal bulb → Duodenal descending part. When unwinding the J-shaped or U-shaped loop of the endoscope at the gastric fundus, withdraw the scope while releasing the spiral, rotating toward the anterior wall or greater curvature side to avoid touching the gastric wall. When observing residual stomach, avoid twisting on the lesser curvature which may scrape the mucosa. It is better to form a J-shape on the anterior wall first, then slowly turn toward lesser curvature and posterior wall. 内镜在胃底形成J形、U形袢，解除螺旋时，向前壁侧或者大弯侧回转、退镜同步解袢，减少镜身摩擦胃壁。观察残胃同理：不要直接在小弯处打螺旋，优先在前壁侧形成J形，再缓慢转向小弯、后壁。 When advancing from the duodenal bulb to the descending part, cross the superior duodenal angle with upward spiral movement and rotate the endoscope toward the 3 o’clock direction. 从十二指肠球部向降部进镜，越过十二指肠上角时，一边向上打螺旋，一边向3点钟方向旋转内镜，平稳进入降部，寻找Vater乳头。 到达最深位置（十二指肠降部）后，开始退镜，由远及近依次观察：十二指肠降部→球部→胃窦→胃体→胃底→食管，按顺序扫查各个壁，前壁、后壁、大小弯逐一覆盖，避免盲区。 After reaching the deepest site (duodenal descending part), withdraw the scope and observe from distal to proximal: duodenal descending part → bulb → gastric antrum → gastric body → gastric fundus → esophagus. Inspect every wall systematically to avoid blind spots. 方位判断的核心：记住每个解剖段的标志性结构。进镜重在平顺、少摩擦黏膜；退镜才是仔细观察、排查病变的关键。固定一套标准化流程，能养成稳定的内镜习惯，减少漏诊。 The core of orientation judgment is memorizing landmarks of each segment. Intubation focuses on smooth manipulation and avoiding mucosal injury; careful lesion screening is mainly performed during withdrawal. A standardized workflow helps form stable endoscopic habits and reduce missed diagnosis.
一、方位识别要点（看图辨位置）
Key Points of Orientation Recognition
二、进镜操作顺序与技巧
Intubation Sequence and Manipulation Skills
1. 胃底解螺旋操作
2. 球部到降部的跨越操作
三、退镜观察顺序（重点！观察主要在退镜时完成）
Withdrawal Observation Sequence (Critical: Most observation is completed during withdrawal)
四、小结
Summary
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