色素内镜在近端结肠息肉筛查中的临床应用研究(1)
摘要：目的 对比常规肠镜与色素内镜对近端结肠(盲肠至结肠肝曲)息肉检出率的差异。方法 选取我院2015年7月～2017年7月行肠镜检查患者200例，随机分为常规内镜组和色素内镜组(近端结肠染色)，每组100例。统计患者的近端结肠病变检出情况(数量、大小、形态及病理)，对比两组近端结肠息肉检出率、近端结肠退镜观察时间。结果 两组共检出息肉47个，色素内镜组近端结肠息肉检出率为21.00%，高于常规内镜组的10.00%，差异有统计学意义(P<0.05)。色素内镜组直径<5 mm息肉数量高于常规内镜组，差异有统计学意义(P<0.05)。两组腺瘤、高危腺瘤、扁平腺瘤检出个数以及近端结肠退镜观察时间比较，差异无统计学意义(P>0.05)。结论 色素内镜可显著提高直径<5 mm近端结肠息肉的检出率，以及腺瘤、高危腺瘤和扁平腺瘤的检出率。
关键词：色素内镜;近端结肠;高危腺瘤;扁平腺瘤;间歇期癌
中图分类号：R574 文献标识码：A DOI：10.3969/j.issn.1006-1959.2019.07.025
, 百拇医药
文章编号：1006-1959(2019)07-0086-03
Abstract：Objective To compare the difference in the detection rate of polyps between the proximal colon (cecal and colonic hepatic flexion) by conventional colonoscopy and chromoendoscopy. Methods A total of 200 patients who underwent colonoscopy from July 2015 to July 2017 were randomly divided into the conventional endoscopy group and the chromoendoscopy group (near-end colonic staining)， 100 cases in each group. The incidence of proximal colonic lesions (quantity， size， morphology and pathology) was statistically analyzed. The detection rate of proximal colon polyps and the time of proximal colonoscopy were compared. Results 47 polyps were detected in the two groups. The detection rate of proximal colon polyps in the endoscopic group was 21.00%， which was higher than that in the conventional endoscopy group 10.00%，the difference was statistically significant (P<0.05). The number of polyps <5 mm in the endoscopic group was higher than that in the conventional endoscopy group，the difference was statistically significant (P<0.05). There were no significant differences in the number of adenomas， high-risk adenomas， and flat adenomas， and the time of proximal colonoscopy，the difference was not statistically significant (P>0.05). Conclusion Endoscopic ultrasonography can significantly improve the detection rate of proximal colon polyps with diameter <5 mm， as well as the detection rate of adenoma， high-risk adenoma and flat adenoma.
, 百拇医药
Key words：Endoscopic endoscopy;Proximal colon;High risk adenoma;Flat adenoma;Intermittent cancer
結直肠癌(carcinoma of colon and rectum)是我国常见的恶性肿瘤之一，其发病率和死亡率逐年升高，已跃居第3～5位，其根本原因是我国早期结直肠癌以及癌前病变的检出率较低[1，2]。结肠镜检查是目前认为可以有效提高结直肠癌早期诊断率和减少死亡率的主要手段，而结肠镜对近端结肠(盲肠至结肠肝曲)的保护作用达不到远端结肠(结肠肝曲至直肠)[3]。目前对此最合理的解释是发生间歇期结直肠癌[4]，Le Clercq CM[5]等研究显示间歇期结直肠癌最主要的原因是漏检(57.80%)。与非间歇期结直肠癌相比，间歇期结直肠癌更常出现在右侧，且瘤体更小，形状更加扁平[6]。因此必须加强对近端结肠的详细检查，并识别这些扁平、微小、非隆起的病变。色素内镜是发现扁平、凹陷型病变的工具，是一种简便、安全的检查手段。一项Meta分析[7]结果显示，与普通内镜相比，只有色素内镜能显著提高结直肠腺瘤的检出率，而窄带成像和前置透明帽均不可以。目前较多的是普通肠镜发现可疑病灶后行靛胭脂染色进一步判断病变性质，而本研究通过常规近端结肠靛胭脂染色，对比两种内镜检查在近端结肠病变检出的差异。, 百拇医药(朱季军 刘云云 王艳)
关键词：色素内镜;近端结肠;高危腺瘤;扁平腺瘤;间歇期癌
中图分类号：R574 文献标识码：A DOI：10.3969/j.issn.1006-1959.2019.07.025
, 百拇医药
文章编号：1006-1959(2019)07-0086-03
Abstract：Objective To compare the difference in the detection rate of polyps between the proximal colon (cecal and colonic hepatic flexion) by conventional colonoscopy and chromoendoscopy. Methods A total of 200 patients who underwent colonoscopy from July 2015 to July 2017 were randomly divided into the conventional endoscopy group and the chromoendoscopy group (near-end colonic staining)， 100 cases in each group. The incidence of proximal colonic lesions (quantity， size， morphology and pathology) was statistically analyzed. The detection rate of proximal colon polyps and the time of proximal colonoscopy were compared. Results 47 polyps were detected in the two groups. The detection rate of proximal colon polyps in the endoscopic group was 21.00%， which was higher than that in the conventional endoscopy group 10.00%，the difference was statistically significant (P<0.05). The number of polyps <5 mm in the endoscopic group was higher than that in the conventional endoscopy group，the difference was statistically significant (P<0.05). There were no significant differences in the number of adenomas， high-risk adenomas， and flat adenomas， and the time of proximal colonoscopy，the difference was not statistically significant (P>0.05). Conclusion Endoscopic ultrasonography can significantly improve the detection rate of proximal colon polyps with diameter <5 mm， as well as the detection rate of adenoma， high-risk adenoma and flat adenoma.
, 百拇医药
Key words：Endoscopic endoscopy;Proximal colon;High risk adenoma;Flat adenoma;Intermittent cancer
結直肠癌(carcinoma of colon and rectum)是我国常见的恶性肿瘤之一，其发病率和死亡率逐年升高，已跃居第3～5位，其根本原因是我国早期结直肠癌以及癌前病变的检出率较低[1，2]。结肠镜检查是目前认为可以有效提高结直肠癌早期诊断率和减少死亡率的主要手段，而结肠镜对近端结肠(盲肠至结肠肝曲)的保护作用达不到远端结肠(结肠肝曲至直肠)[3]。目前对此最合理的解释是发生间歇期结直肠癌[4]，Le Clercq CM[5]等研究显示间歇期结直肠癌最主要的原因是漏检(57.80%)。与非间歇期结直肠癌相比，间歇期结直肠癌更常出现在右侧，且瘤体更小，形状更加扁平[6]。因此必须加强对近端结肠的详细检查，并识别这些扁平、微小、非隆起的病变。色素内镜是发现扁平、凹陷型病变的工具，是一种简便、安全的检查手段。一项Meta分析[7]结果显示，与普通内镜相比，只有色素内镜能显著提高结直肠腺瘤的检出率，而窄带成像和前置透明帽均不可以。目前较多的是普通肠镜发现可疑病灶后行靛胭脂染色进一步判断病变性质，而本研究通过常规近端结肠靛胭脂染色，对比两种内镜检查在近端结肠病变检出的差异。, 百拇医药(朱季军 刘云云 王艳)