常规内镜 窄带内镜 全结肠色素内镜及全结肠醋酸喷洒对结肠病变发现率的对比研究

Detecting colorectal lesions at colonoscopy:a randomized controlled comparison trial of conventional imaging,narrow band imaging,pancolonic indigo carmine and acetic acid dye

目的比较常规内镜与窄带内镜(NBI)、全结肠色素内镜及全结肠醋酸喷洒对结肠病变的发现率。方法选择2006年4月至6月就诊于首都医科大学附属北京友谊医院消化内科准备接受结肠镜检查的患者240例,用随机数字表法将患者分为4组:其中常规内镜组61例、NBI组63例、全结肠色素内镜组54例、醋酸染色组62例。观察各组间扁平及隆起病变部位、数量,并且对各组间操作时间、患者痛苦评分及检查费用进行比较。结果在4组中,共发现233枚病变,其中扁平病变90枚(38.6%),隆起病变143枚(61.4%)。扁平病变常规内镜共发现18枚(29.5%),而全结肠靛胭脂染色组发现32枚(59.3%)病变,差异有统计学意义(P<0.05)。隆起病变常规内镜共发现22枚(36.1%),而全结肠醋酸染色组发现55枚(88.7%)病变,差异有统计学意义(P<0.01)。但是与常规内镜相比,窄带内镜、全结肠色素内镜及全结肠醋酸喷洒染色对于结肠腺瘤及癌变的诊断数量及诊断率没有提高。与常规内镜组相比,除操作时间有所延长外,其余3组患者痛苦程度及费用都没有明显差别(P>0.05)。结论全结肠色素内镜及全结肠醋酸喷洒可提高结肠病变的发现率,前者可以提高扁平病变的发现率,后者可提高隆起病变的发现率。

Objective To investigate the differences between conventional imaging,narrow band imaging,pancolonic indigo carmine and acetic acid dye on the lesion detection during colonoscopy. Methods Two hundred and forty outpatients undergoing routine colonoscopy were randomized into four different groups： conventional imaging, pancolonic indigo carmine dye, narrow band imaging and pancolonic acetic acid dye. Patients＇ demorgraphics, quality of bowel preparation, extubation time, visual analogue scale（VAS） pain score during the procedure, the number and location of flat or protuberant lesions and cost were documented. Results Totally 233 lesions were detected during colonoscopy in 4 groups,with flat lesions 90（38. 6% ）and protuberant lesions 143 （61.4%）. For flat lesions, compared with lesions detected in conventional colonoscopy group（ n = 18） ,lesions in group of pancolonic indigo carmine dye were 32,the difference between two groups being significant with p value less than 0. 05. For protuberant lesions, compared with lesions detected in conventional colonoscopy group（ n = 22） ,lesions in group of pancolonic acetic acid dye were 55, the difference between two groups being significant with P value less than 0. 01. But compared with that of conventional colonoscopy,no improvement was found in detection rate and number for neoplastic lesions for the other three groups. The extubation time was much longer for the group of pancolonic indigo carmine dye （ 14. 32 ± 7. 53 ）min, narrow band imaging（ 12. 12 ± 7. 11 ）min and pancolonic acetic acid dye （ 13.03 ± 7. 03 ） min, when compared with conventional colonoscopy group （ 9. 88 ± 4. 18 ） min, and the difference was statistically significant. There were no statistically significant differences between conventional colonoscopy group and the other three groups with respect to VAS value of pain and cost. Conclusion Endoscopic dye spraying of the colorectal mucosa with indigo carmine and acetic acid can improve the detection rate of colorectal lesions,with the former for flat lesions and the latter for protuberant lesions.