摘要
目的通过分析不同时机内镜切除大肠多发息肉的漏检率，评价进退镜全程切除多发息肉的效果及安全性。方法200例首次肠镜检查确诊为大肠多发息肉的患者，按随机数字表法分为2组。A组（n=101）第2次肠镜检查时只在退镜过程中切除息肉；B组（n=99）第2次肠镜检查时在进镜过程中切除直径〈10mm的息肉，在退镜过程中发现息肉即行切除。对比分析2组第2次肠镜检查的息肉漏检率、息肉新发现率、手术时间以及并发症发生情况，并采用Logistic回归分析方法分析息肉漏检的相关危险因素。结果A组首次肠镜检查发现息肉443枚，第2次肠镜检查发现并切除其中403枚，新发现并切除息肉11枚，共计切除息肉414枚；B组首次肠镜检查发现息肉437枚，第2次肠镜检查检出并切除其中421枚，新发现并切除息肉28枚，共计切除息肉449枚。息肉漏检率A组明显高于B组[8．8％（40／454）比3．4％（16／465），P〈0．001]，息肉新发现率A组明显低于B组[2．4％（11／454）比6．0％（28／465），P=0．024]，内镜手术时间A组明显长于B组[（32．2±5．8）min比（25．5±5．0）min，P〈O．001]，2组均无一例发生穿孔、大出血等并发症。多因素Logistic回归分析显示，直径〈10mm的息肉（OR=8。471，95％CI：2．527～28．395）、平坦型息肉（OR=10．865，95％C1-3．360-35．134）和位于左半结肠的息肉（OR=7．631，95％CI：2．361—24．666）容易漏检。结论退镜过程中切除大肠多发息肉存在漏检情况，采取进镜过程中切除直径〈10mm的息肉，而退镜过程中发现息肉即行切除，可减少漏检情况、缩短内镜手术时间，并且不会明显增加并发症的发生，值得临床进一步研究，但仍应警惕直径〈10mm、平坦型、分布于左半结肠这几个易发大肠多发息肉漏检的高危因素。
Objective To evaluate the effect and safety of colorectal polypectomy during insertion and withdrawal through analysis of the miss rate in different phases. Methods A total of 200 patients with colorectal polyps detected by endoscopy were divided into two groups randomly according to random number table method. In group A （n = 101 ）, polyps were removed during withdrawal only, while in group B （n = 99）, polyps〈 10 mm in diameter were removed during insertion in the second colonoseopy and the remainder and newly discovered polyps were removed during withdrawal of the colonoscopes. The miss rate, newly discovery rate, endoscopy time and complications were evaluated. And the possible risk factors were calculated with lo- gistic regression analysis. Results In group A, 443 polyps were found during the first endoscopy, 403 pol- yps and 11 newly discovered were detected and removed during the second endoscopy, which were 414 polyps in total. While in group B, 437 polyps were found during the first endoscopy, 421 polyps and 28 new- ly discovered were detected and removed during the second endoscopy, which were 449 polyps in total. The pooled miss rate of polyps in group A was significantly higher than that in group B [ 8. 8% （40/454）VS 3.4% （16/465） ,P〈0. 001 ]. The newly detection rate of polyps in group A was significantly lower than that in group B[ 2. 4% （11/454）VS 6.0% （28/465）, P = 0. 0241 .The mean endoscopic procedure time in group A was significantly longer than that in group B[ （ 32. 2±5.8） min VS（25.5±5.0） rain,P〈0. 001 ） .There were no complications such as perforation, massive hemorrhage and so on found in either group. Logistic regression analysis showed that number of polyps 〈 10 mm （ OR = 8. 471,95% CI： 2. 527-28. 395 ）, fiat polyp （ OR = 10. 865,95% CI： 3. 360-35. 134） and location in the left colon （ OR = 7. 631,95% CI： 2. 361-24. 666） were sig- nificantly related to the miss rate of eolorectal polyps （P〈 0. 05 ）. Conclusion Removal of
出处
《中华消化内镜杂志》
北大核心
2016年第8期522-526,共5页
Chinese Journal of Digestive Endoscopy
关键词
结肠镜检查
漏检
息肉切除
手术时机
Colonoscopy
Missed detection
Polypectomy
The timing of endoscopic surgery
