自发荧光内镜与标准白光内镜在大肠息肉筛查中作用的对照研究

Comparison of autofluorescence imaging （AFI） and white light （WL） endoscopy in screening of colon polyps

目的比较自发荧光内镜成像技术（AFI）模式下和标准白光技术（WL）模式下内镜对大肠息肉检出率的差异。方法对2008年12月至2009年8月间纳入的562例按照计算机随机数字表分成2组。A组在WL模式下进镜至盲肠后，用WL模式退镜检查至直肠，接着再次用WL模式进镜至盲肠，然后改用AFI模式退镜检查至直肠；B组退镜检查与A组顺序相反。在首次发现息肉时即取活检，以示标记，并记录下息肉的部位、大小及形态，所有活检标本送组织学检查以明确病理类型。结果在A组中，WL模式下先发现息肉78枚，AFI模式下新发现额外息肉28枚；在B组中，AFI模式下先发现息肉106枚，WL模式下新发现额外息肉20枚。对数据进行统计显示，AFI模式下内镜对息肉的漏诊率为15．9％（20／126），显著低于WL模式下的26．4％（28／106）（P=0．041）。结论AFI内镜对于大肠息肉的筛查敏感性高，且操作简单易行，可推广应用。

Objective To compare the detective rates of colonic polyps with autofluorescence ima- ging （AFI） and white light （WL） endoscopy. Methods A total of 562 patients, who underwent colonosco- py for screening of colon polyps, were recruited from December 2008 to April 2009 and randomized into 2 groups. All patients received 2 times of colonoscopy. For those in group A, the colonoscopy was inserted to cecum and withdrawn to rectum at WL mode in first examination, and the scope was inserted again into ce- cum under WL mode and withdrawn to rectum at AFI mode. For those in group B, the withdrawal procedures were performed reversely. Biopsies were performed at the first discovery of polyps as a marker. Location, shape and size of the polyp were recorded. All biopsy specimens were histopathologically examined. Results In group A, 78 polyps were detected under WL mode and 28 additional in AFI. In group B, 106 polyps were detected in AFI and 20 additional in WL. The rate of missed diagnosis of AFI for all polyps （ 15.9% ） was significantly lower than that of WL （26. 4%, P = 0.041 ）. Conclusion AFI endoscopy is sensitive in detection of colonic polyps and easy to manipulate, which is useful in screening of colon polyps.