结直肠癌筛查高危患者结肠镜下息肉与腺瘤检出率的影响因素

Factors influencing the detection rates of colonoscopic polyp and adenoma in high-risk population in colorectal cancer screening

目的探讨结直肠癌筛查高危患者影响息肉／腺瘤检出率的因素。方法选取2014年5月至2014年11月期间在行结直肠癌筛查阳性后，再行结肠镜检查的患者。按受检者性别、年龄、是否有腹部手术史、是否无痛、肠道准备情况、操作者经验等不同分别计算息肉／腺瘤检出率，各组间检出率的差异采用r检验进行评估，对有统计学意义的因素应用Logistic回归进行多因素分析。结果共有417例患者入组，总的息肉检出率为35．25％，单因素分析显示性别（OR=2．298，95％CI：1．525～3．463）、是否有腹部手术史（OR=0．596，95％CI：0．390～0．910）、是否无痛（OR=1．864，95％CI：1．086—3．200）以及肠道准备情况影响息肉检出率，而多因素分析显示只有性别、腹部手术史及肠道准备情况是其独立预测因素。总的腺瘤检出率为30．22％，单因素分析显示性别（OR=2．113，95％C1：1．382—3．229）、是否有腹部手术史（OR=0．604，95％C1：0．387～0．941）、是否无痛（OR=2．344，95％CI：1．283～4．281）以及肠道准备情况影响腺瘤检出率，而多因素分析显示只有性别、腹部手术史及肠道准备情况是其独立预测因素。结论对于结直肠癌筛查阳性患者，男性较女性有更大的息肉、腺瘤发生风险，有腹部手术史的患者需要更加仔细检查，肠道准备质量对息肉／腺瘤检出率有明显影响。

Objective To investigate the influential factors for the colonoscopic polyp detection rate （PDR） and adenomade detection rate（ADR） in high-risk population in community coloreetal cancer screen- ing. Methods Data of patients who were determined as high-risk population in community eolorectal cancer screening tests and received eolonoscopy in the Digestive Endoscopic Center of Tongji Hospital from May 2014 to November 2014 were collected. PDR and ADR were calculated by different genders, ages, history of abdominal operation, anesthesia assistance, quality of bowel preparation and experience of operators. Thex2 test and logistic regression analysis were used to compare the PDR and ADR between different groups. Re- suits A total of 417 patients received complete colonoscopies. The total PDR was 35.25%. Univariate a- nalysis revealed that gender （ OR = 2. 298,95% CI： 1. 525-3.463 ）, history of abdominal operation （ OR = 0. 596,95% CI：O. 390-0. 910）, anesthesia assistance （ OR = l. 864,95% CI： 1. 086-3. 200） and quality of bowel preparation were significantly associated with PDR while multivariate analysis revealed that only gen- der, history of abdominal operation and quality of bowel preparation were independent influential factors for PDR. The total ADR was 30. 22%. Like PDR, univariate analysis revealed that gender（ OR =2. 113,95% CI： 1. 382-3. 229）, history of abdominal operation（ OR = 0. 604,95% CI：O. 387-0. 941 ）, anesthesia assis- tance（ OR = 2. 344,95% CI： 1. 283-4. 281 ） and quality of bowel preparation were significantly associated with ADR. However, multivariate analysis revealed that only gender, history of abdominal operation and quality of bowel preparation were independent influential factors for ADR. Conclusion For patients who were high-risk in community colorectal cancer screening, men have greater risk to develop polyps and adenomas than women. Colonoscopy should be more careful in patients with history of abdominal operation, for quality of bowel preparation is directly related to PDR and AI）R.