内镜下运用刻度活检钳进行息肉大小测量的临床价值

Study on accuracy of endoscopic polyp size measurement by disposable graduated biopsy forceps

目的探讨一次性刻度活检钳在内镜下测量息肉大小的准确性。方法从一次性活检钳钢丝的起始部开始，以医用颜料刻画间隔为1mm的刻度制作刻度活检钳，作为在内镜下评估肿瘤大小的标尺，前瞻性估计南京中医药大学第三附属医院全国肛肠医疗中心2013年5—6月间内镜检查发现的58枚（43例患者）结直肠息肉的大小，并比较其与内镜下常规估计值及圈套切除后直接测量值的差异。结果58枚结直肠息肉切除后，息肉实际测量的最大径为（1．02±0．84）cm，其中小于1cm者36枚，1～2cm者15枚，大于2cm者7枚。内镜下常规估计的息肉最大径为（1．29±1．07）cm，与实际测量值的差异有统计学意义（P=0．000）；内镜下刻度活检钳评估的息肉最大径为（1．02±0．82）cm，与实际测量值的差异无统计学意义（P=0．775）。内镜下常规估计值与实际测量值的比值为1．29±0．31，而刻度活检钳估计值与实际测量值的比值为1．02±0．11，差异有统计学意义（P=O．000）。内镜下刻度活检钳估计对息肉大小的判断准确率为77．6％（45／58），明显高于内镜下常规估计[19．0％（11／58），P=0．000]。结论使用内镜下刻度活检钳作为“标尺”，对息肉大小判断，其判断准确性较内镜下常规凭经验进行估计明显提高。

Objective To study the accuracy of endoscopic polyp size measurement by disposable graduated biopsy forceps （DGBF）. Methods Accurate gradation of 1 mm was made in the wire of disposable graduated biopsy forceps, which was used to measure the size of tumors under endoscopy. Fifty-eight polyps from 43 patients underwent endoscopy in our department from May to June 2013 were enrolled. Size of polyp was measured and compared among DGBF, routine estimation and direct measurement after resection. The accuracy of polyp size measurement was investigated by four colonoscopists who had finished at least 2000 procedures of colonoscopy. Results The mean diameter of post-polypectomy measurement was （1.02±0.84） cm. Diameter was less than 1 cm in 36 polyps, 1 to 2 cm in 15, and over 2 cm in 7. The mean diameter of visual estimation was （1.29±1.07） cm, and the difference was significant as compared with actual size （P=0.000）. The mean diameter measured by DGBF was （1.02±0.82） cm, and the difference was not significant as compared with actual size （P=0.775）. The ratio of visual estimation to actual size was 1.29-±0.31, and DGBF estimation to actual size was 1.02±0.11 with significant difference（P=0.000）. The accurate rate of DGBF in estimating polyp size was 77.6%（45/58）, which was obviously higher as compared to visual estimation [ 19.0%（11/58）, P=- 0.000]. Conclusion The accuracy of DGBF as a scale in the estimation of poly size increases ascompared to visual estimation.