结肠镜退镜时间与结直肠息肉检出率的回顾性研究

Withdrawal Time of Colonoscopy and Detection Rate of Colorectal Polyps:A Retrospective Study

背景:结肠镜检查是结直肠癌筛查的重要手段,但其检查质量受退镜时间、肠道清洁程度等多种因素影响,一般推荐退镜时间不低于6 min。目的:探讨结肠镜检查退镜时间与反映结肠镜检查质量的重要指标息肉检出率的关系。方法:采用回顾性研究设计,纳入2018年9月—2019年9月在上海仁济医院南院行结肠镜检查的患者2924例,结肠镜操作由2名高年资消化内镜专科医师完成。按是否检出息肉将患者分为息肉组与无息肉组,比较两组性别、年龄以及回盲部到达时间、进镜深度和退镜时间,采用logistic回归模型分析息肉检出相关因素。结果:2924例结肠镜检查者中,1105例(37.8%)发现结直肠息肉,息肉组与无息肉组间性别构成、回盲部到达时间差异有统计学意义(P<0.05)。Logistic回归分析显示,男性(OR=3.175,95%CI:1.596~6.317,P=0.001)和退镜时间≥5 min(OR=4.945,95%CI:2.037~12.005,P<0.001)与息肉检出显著相关。结论:对于高年资消化内镜专科医师,将结肠镜检查的退镜时间控制在5~6 min可能达到风险与获益的平衡。

Background:Colonoscopy is an important approach for the screening of colorectal cancer,however,the quality of colonoscopy is affected by a series of factors such as withdrawal time and bowel cleanliness.It is recommended that colonoscopy withdrawal time should not be less than 6 minutes.Aims:To study the relationship between withdrawal time of colonoscopy and the detection rate of colorectal polyps,which is considered as an important quality indicator for colonoscopy.Methods:A total of 2924 cases of patients who underwent colonoscopy at the Southern Division of Shanghai Renji Hospital from September 2018 to September 2019 were enrolled in this retrospective study.Colonoscopies were performed by two experienced senior endoscopists.Patients were divided into two groups according to the presence of colorectal polyps.The gender,age,cecal insertion time,depth of insertion and withdrawal time were recorded and compared between the two groups.The influential factors for detection of colorectal polyps were analyzed by logistic regression model.Results:Of the 2924 cases,1105(37.8%)found polyps under colonoscopy.There were significant differences in gender and cecal insertion time between the two groups(P<0.05).Logistic regression analysis revealed that male(OR=3.175,95%CI:1.596-6.317,P=0.001)and withdrawal time≥5 min(OR=4.945,95%CI:2.037-12.005,P<0.001)were associated with detection of colorectal polyps.Conclusions:For experienced senior endoscopists,the risk-benefit balance might be achieved by controlling the colonoscopy withdrawal time within 5-6 minutes.