摘要
目的分析结肠镜检查时结直肠息肉的漏诊情况,探讨息肉漏诊的危险因素,指导临床医师减少结肠镜下息肉的漏诊。方法选择该院3个月内先后2次行结肠镜检查的患者,收集病例资料,将第2次肠镜检查时新发现的息肉判定为漏诊息肉。采用χ2检验分析结肠息肉漏诊的危险因素,采用Logistic回归方法分析接受检查的患者出现漏诊的危险因素。结果入选343枚息肉,漏诊81枚,按息肉枚数分析的漏诊率为23.62%。入选240例患者,漏诊54例,按患者分析的漏诊率为22.5%。扁平型息肉的漏诊率显著高于隆起型(31.08%与3.26%,P<0.05)。小于5 mm的息肉漏诊率显著高于5 mm以上的息肉(45.8%与5.32%,P<0.05)。Logistic回归分析显示退镜时间不充分(<6 min)、息肉为多发、检查医师为初学者(结肠镜检查少于500例)均为患者出现息肉漏诊的独立危险因素(均P<0.001),三者的比值比(OR)分别为6.70[95%可信区间(CI)2.918-15.400]、3.60(95%CI 1.663-7.80)及8.73(95%CI 3.974-19.195)。结论结肠镜检查时存在较多的息肉漏诊。扁平息肉、小息肉为息肉漏诊的危险因素。结肠镜退镜时间不充分、医生经验不足、息肉多发是患者漏诊的危险因素。
[ Objective ] To analyze the missing rate of colorectal polyps during colonoscopy as well as factors in- fluencing the missing rate and instruct the endoscopists to reduce the missing of colorectal polyps during colonoscopy. [ Methods ] We reviewed the patients who underwent repeated colonoscopies in 3 months,the polyps newly detected in second colonoscopy were defined as missed polyps. Chi-square test and logistic regression analysis was used to analyze the risk factors influencing the missing rate per polyps and per patient respectively. [ Results ] In 343 polyps reviewed, 81 were missed, missing rate per polyp was 23.62%. 54 in 240 patients were missed for at least one polyp, missing rate per patient was 22.5%. Polyps of flat type had a significantly higher missing rate as compared with polyps of protrude type （31.087% vs 3.26%, P 〈0.05）. Missing rate of polyps less than 5ram was sig- nifieantly higher than polyps at least 5ram in size （45.8% vs 5.32%, P 〈0.05）. Insufficient withdrawal time （〈6 min）, multiple polyps and junior endoseopists （who performed less than 500 eolonoscopies） were all independent risk fac- tors for patients missed during eolonoseopies（OR were 6.70 [95%CI 2.918-15.400], 3.60 [95%CI 1.663-7.80] and 8.73 [95%CI 3.974-19.195], respectively, P 〈0.001 for all）. [Conclusions] Missing of polyps is a problem in colonoscopy. Polyps of flat type and small size are risk factors for missing per polyps. Insufficient withdrawal time, less experienced endoscopists and muhiple polyps were all risk factors for missin~ oer oatient.
出处
《中国内镜杂志》
CSCD
北大核心
2013年第9期914-918,共5页
China Journal of Endoscopy
关键词
结肠镜
息肉
漏诊
colonoscopy
polyps
missing
