中华普通外科学文献（电子版）
中華普通外科學文獻（電子版）
중화보통외과학문헌（전자판）
CHINESE JOURNAL OF GENERAL SURGERY(ELECTRONIC VERSION)
2013年
6期
480-484
,共5页
严岳%曾慧%黄金圣%李玉洁%林秉勋
嚴嶽%曾慧%黃金聖%李玉潔%林秉勛
엄악%증혜%황금골%리옥길%림병훈
直肠息肉%肛门指检%结肠镜检
直腸息肉%肛門指檢%結腸鏡檢
직장식육%항문지검%결장경검
Colorectal polyps%Digital rectal examination%Colonoscopy
目的：分析肛门指检及结肠镜检中低位直肠息肉的漏诊率及漏诊息肉特征，探讨结肠镜检结合肛门指检的重要性。方法收集2012年9月至2013年5月在体检中心先后接受肛门指检及结肠镜检的244例受检者，分别对两种方法检查低位直肠息肉的漏诊情况进行分析。结果89例发现直肠息肉并切除息肉143个。65例在距离肛门＜7 cm肠段发现息肉94个，其中15例肛门指检漏诊息肉23个，29例结肠镜检漏诊息肉38个，结肠镜检的漏诊率高于肛门指检（24.5%v s 40.4%，χ2=5.460，P=0.019）。小息肉、平坦型息肉容易被漏诊；多发性息肉患者漏诊率较高；初级医师的息肉漏诊率明显高于有经验医师；肛门指检时间＜2 min者的漏诊率高于≥2 min者；结肠镜检操作时间＜35 min者的漏诊率高于≥35 min者；结肠镜检距离肛门≤3 cm的息肉的漏诊率明显高于肛门指检，差异均有统计学意义（P＜0.05）。结论结肠镜检和肛门指检均存在漏诊息肉的可能，息肉漏诊与息肉大小、形态、数目、病理以及操作医师、检查时间密切相关。结肠镜检查结合肛门指检，能降低低位直肠息肉的漏诊率。
目的：分析肛門指檢及結腸鏡檢中低位直腸息肉的漏診率及漏診息肉特徵，探討結腸鏡檢結閤肛門指檢的重要性。方法收集2012年9月至2013年5月在體檢中心先後接受肛門指檢及結腸鏡檢的244例受檢者，分彆對兩種方法檢查低位直腸息肉的漏診情況進行分析。結果89例髮現直腸息肉併切除息肉143箇。65例在距離肛門＜7 cm腸段髮現息肉94箇，其中15例肛門指檢漏診息肉23箇，29例結腸鏡檢漏診息肉38箇，結腸鏡檢的漏診率高于肛門指檢（24.5%v s 40.4%，χ2=5.460，P=0.019）。小息肉、平坦型息肉容易被漏診；多髮性息肉患者漏診率較高；初級醫師的息肉漏診率明顯高于有經驗醫師；肛門指檢時間＜2 min者的漏診率高于≥2 min者；結腸鏡檢操作時間＜35 min者的漏診率高于≥35 min者；結腸鏡檢距離肛門≤3 cm的息肉的漏診率明顯高于肛門指檢，差異均有統計學意義（P＜0.05）。結論結腸鏡檢和肛門指檢均存在漏診息肉的可能，息肉漏診與息肉大小、形態、數目、病理以及操作醫師、檢查時間密切相關。結腸鏡檢查結閤肛門指檢，能降低低位直腸息肉的漏診率。
목적：분석항문지검급결장경검중저위직장식육적루진솔급루진식육특정，탐토결장경검결합항문지검적중요성。방법수집2012년9월지2013년5월재체검중심선후접수항문지검급결장경검적244례수검자，분별대량충방법검사저위직장식육적루진정황진행분석。결과89례발현직장식육병절제식육143개。65례재거리항문＜7 cm장단발현식육94개，기중15례항문지검루진식육23개，29례결장경검루진식육38개，결장경검적루진솔고우항문지검（24.5%v s 40.4%，χ2=5.460，P=0.019）。소식육、평탄형식육용역피루진；다발성식육환자루진솔교고；초급의사적식육루진솔명현고우유경험의사；항문지검시간＜2 min자적루진솔고우≥2 min자；결장경검조작시간＜35 min자적루진솔고우≥35 min자；결장경검거리항문≤3 cm적식육적루진솔명현고우항문지검，차이균유통계학의의（P＜0.05）。결론결장경검화항문지검균존재루진식육적가능，식육루진여식육대소、형태、수목、병리이급조작의사、검사시간밀절상관。결장경검사결합항문지검，능강저저위직장식육적루진솔。
Objective To analyze the rates of missed diagnosis of digital rectal examination and colonoscopy and to explore the importance of colonoscopy combining digital rectal examination in patients with low rectal polyps. Methods Two hundred and forty-four patients receiving colonoscopy and digital rectal examination at the same time were retrospectively evaluated. The differences of missed diagnosis between the two methods were assessed by the Chi-square test. Results One hundred and forty-three polyps in 89 patients were diagnosed and resected in our hospital. The mean polyp diameter was (0.59±0.35) cm. Ninty-four polyps in 65 patients were found located less than 7 cm to anus. Among them, 23 polyps in 15 patients were missed diagnosis with digital rectal examination, and the missed diagnosis rate was 24.5%;38 polyps in 29 patients were with colonoscopy, the missed diagnosis rate was 40.4%. The rate of missed diagnosis by digital rectal examination was lower than colonoscopy,χ2=5.460, P=0.019. According to subgroup analyses, small polyps, flat polyps and multiple polyps tended to be missed diagnosis. The rate of missed diagnosis of colonoscopy operated by junior endoscopists was significantly higher than that operated by experienced endoscopists. The missed rate of digital rectal examination for<2 minutes was significantly higher than that for≥2 minutes. The missed rate of colonoscopy operated for<35 minutes was significantly higher than that operated for≥35 minutes. The rate of missed diagnosis of colonoscopy was significantly higher than digital rectal examination in examining polyps located<3 cm from anus. All the above differences were statistically significant, P<0.05. Conclusions Both colonoscopy and digital rectal examination may result in missed polyps. The rate of missed diagnosis is associated with polyp size, shape, number, pathology, operating physician, and the time of examination. Using colonoscopy combined digital rectal examination can reduce the missed diagnosis rate of low rectal polyps.
