肠镜前置透明帽对结肠息肉诊断的影响

Efficacy of Transparent Cap-fitted Colonoscopy in Diagnosis of Colonic Polyps

目的探讨肠镜前端安装透明帽对结肠息肉检出的影响。方法分析2010年4月1日-2012年3月31日，在我院接受电子结肠镜发现结肠息肉，并在2个月内由同一操作者行透明帽辅助下肠息肉内镜下黏膜切除术（EMR）或内镜下黏膜剥离术（ESD）的患者资料，记录患者2次肠镜检查出的不同形态、大小的息肉数并进行统计分析。结果63例患者初次检查出息肉301枚，透明帽辅助复查出息肉373枚，在72枚漏诊息肉中，回盲部2枚，升结肠14枚，横结肠16枚，降结肠12枚，乙状结肠23枚，直肠5枚；直径〈5mm息肉42枚，5～9mm息肉23枚，≥10mm息肉7枚：山田I型息肉50枚，Ⅱ型息肉11枚，Ⅲ型息肉7枚，Ⅳ型息肉4枚；透明帽辅助复检对不同部位、大小、形态息肉检出情况均优于首次常规检查，差异有统计学意义（P〈0．05）。结论常规电子结肠镜检查中结肠息肉有较高的漏诊率，且漏诊息肉绝大多数为〈5mm的I型息肉。肠镜前置透明帽可显著降低结肠息肉漏检率，值得在基层医院医生尤其是初学者中推广。

Objective To explore the efficary of transparent cap - fitted colonoscopy in diagnosis of colonic polyps. Methods The data of the patients with eolonie polyps diagnosed by tandem video colonoscopy, who were received endoscopic mucosal resection （EMR） or endoscopic submucosal dissection （ESD） by the same operator in our hospital within 60 days from April 1st 2010 to Mach 31st 2012, were analyzed. The morphology and size of polyps detected two times by the colonoscopy were recorded and statistically analyzed. Results Among the 63 patients 301 polyps were detected at the first examination, and by transparent cap - fitted eolonoscopy 373 polyps were detected. Of the 72 missed diagnosed polyps there were 2 in ileoceeal part, 14 in ascending colon, 16 in transverse colon, 12 in descending colon, 23 in sigrnoid colon, and 5 in rectum; the num- bers of polyps with a diameter 〈 5 mm, 5 - 9 mm, and ~〉 10 mm were 42, 23, 7 respectively; and the counts of Yamada type I , 11 , II1 and 1V were 50, 11, 7, 4 respectively. The detected results by transparent cap - fitted eolonoscopy were better than those at the first examination, with a significant difference （P 〈 0.05） . Conclusion The conventional electronic colonoscopy is of higher rate of missed diagnosis, and the missed are mostly the type I polyps with a diameter 〈 5 mm. The transparent cap - fitted colonoscopy can remarkably reduce the rate of missed diagnosis. It is worth of population in the grass - root hospitals, especially for beginners.