CAJ | 학술논문

目的明确结肠镜检查中大肠腺瘤的漏诊率及漏诊腺瘤特征,探讨腺瘤漏诊的相关危险因素.方法患者在初次结肠镜检查发现并切除腺瘤后120 d内进行结肠镜复查,分析2次结肠镜检查结果.记录2次结肠镜检查所见腺瘤的特征(包括大小、部位、形态、数目及病理)、患者临床特征(包括年龄、性别、结肠镜检查原因、腹部及盆腔手术史、大肠憩室病史及是否行无痛结肠镜检查)及不同的内镜操作医师.分析不同类型腺瘤在结肠镜检查中的漏诊率以及腺瘤特征、患者临床特征和内镜医师的操作水平对腺瘤漏诊的影响.结果 809例患者中271例发生腺瘤漏诊,2次结肠镜检查共检出腺瘤2134颗,漏诊腺瘤425颗,腺瘤总漏诊率为20%(425/2134);平均患者腺瘤漏诊率为33%(271/809).腺瘤体积大者,漏诊率低(P<0.01);乙状结肠、肝曲、盲肠和升结肠部位的腺瘤以及平坦型腺瘤容易漏诊(P<0.05);患者腺瘤数越多在结肠镜检查中腺瘤漏诊率越高(P<0.01);初级内镜医师与有经验内镜医师相比,其漏诊率明显增加(P<0.01).结论结肠镜检查中存在部分腺瘤漏诊,腺瘤漏诊与腺瘤大小、形态、部位、数目以及结肠镜检查操作医师密切相关.
목적 명학결장경검사중대장선류적루진솔급루진선류특정,탐토선류루진적상관위험인소.방법 환자재초차결장경검사발현병절제선류후120 d내진행결장경복사,분석2차결장경검사결과.기록2차결장경검사소견선류적특정(포괄대소、부위、형태、수목급병리)、환자림상특정(포괄년령、성별、결장경검사원인、복부급분강수술사、대장게실병사급시부행무통결장경검사)급불동적내경조작의사.분석불동류형선류재결장경검사중적루진솔이급선류특정、환자림상특정화내경의사적조작수평대선류루진적영향.결과 809례환자중271례발생선류루진,2차결장경검사공검출선류2134과,루진선류425과,선류총루진솔위20%(425/2134);평균환자선류루진솔위33%(271/809).선류체적대자,루진솔저(P<0.01);을상결장、간곡、맹장화승결장부위적선류이급평탄형선류용역루진(P<0.05);환자선류수월다재결장경검사중선류루진솔월고(P<0.01);초급내경의사여유경험내경의사상비,기루진솔명현증가(P<0.01).결론 결장경검사중존재부분선류루진,선류루진여선류대소、형태、부위、수목이급결장경검사조작의사밀절상관.
Objective To investigate the miss rate of adenoma with colonoscopy and assess the features and risk factors for missed diagnosis.Methods Patients with colorectal adenoma received a second colonoscopy within 120 days after adenoma was detected and removed on the initial colonoscopy.The findings of two colonoscopies were reviewed and analyzed.The features of adenoma (including size, location, shape, number and pathology) , clinical characteristics of patients (including age, sex, reasons of colonoscopy, history of diverticular disease, history of abdominal or pelvic surgery and colonoscopy with sedation) and endoscopists were recorded.Miss rate and features of different types of missed adenoma were analyzed.We also assessed the effects of adenoma features, patients' characteristics and endoscopists on missed diagnosis of adenoma.Results Adenoma missed diagnosis was found in 271 patients out of 809 recruited subjects (33% ).A total of 425 adenomas were missed out of 2134 (20% ) adenomas detected by repeated colonoscopy.A large diameter was associated with a decrease in the miss rate for adenoma (P < 0.01).Conversely , sessile or flat shape (P < 0.01) , locations at sigmoid, hepatic flexure, cecum and ascending colonic ( P < 0.05) were significantly associated with a higher miss rate of adenoma, as was the number of adenomas (P <0.01).A higher adenoma missed diagnosis rate was observed in beginner colonoscopists, as compared with experienced ones (P < 0.01).Conclusion A marked miss rate of adenoma exists on colonoscopy, which is significantly associated with the size, shape, location and number of adenomas and endoscopists.