835枚结直肠进展期腺瘤的病例资料特点及漏诊原因分析

Retrospective analysis of individual patients data and misdiagnosis reason in 835 advanced colorectal adenomas

目的分析结直肠进展期腺瘤(advanced colorectal adenoma,ACA)在不同年龄患者中的特点,探讨影响其漏诊及再发的因素。方法收集2012年1月至2017年12月在上海交通大学医学院附属瑞金医院北部院区接受肠镜检查的患者,共纳入符合条件的ACA 835枚,分析这些患者的年龄、性别、检出ACA基数、大小、形态、位置、肠道准备情况,初步了解中青年(≤60岁)及老年(>60岁)患者的ACA特点,探讨其漏诊及再发的相关因素。结果在漏诊的中青年ACA中,性别、肠道准备情况组间比较,差异有统计学意义(P<0.05),男性及肠道准备欠佳者易出现漏诊情况(P=0.001、P=0.000),而肠镜ACA基数、大小、位置组间比较,差异无统计学意义(P>0.05)。在再发的中青年ACA中,性别组间比较差异有统计学意义(P=0.005)。在漏诊的老年ACA中,男性、多发ACA、扁平或宽蒂的结直肠ACA、肠道准备欠佳者易出现漏诊情况(P=0.002、P=0.023、P=0.001、P=0.000),而ACA大小、位置组间比较,差异无统计学意义(P>0.05)。在再发的老年ACA中,同中青年ACA,性别组间比较差异有统计学意义(P=0.040),而肠镜ACA基数、大小、形态、位置、肠道准备情况差异无统计学意义(P>0.05)。对ACA的漏诊及再发相关因素进行Logistic回归分析发现,患者的年龄(OR=0.608,P=0.007)、性别(OR=2.553,P=0.000)、Boston评分(OR=0.464,P=0.000)是影响ACA漏诊的独立危险因素,而患者的性别(OR=1.589,P=0.018)是影响ACA再发的独立危险因素。结论年龄越大、男性、肠道准备差会导致ACA的漏诊,而男性ACA的再发风险更高。

Objective To analyse the characteristics of advanced colorectal adenomas(ACA)at different ages and the influencing factors of missed diagnosis and recurrence.Methods A total of 835 clinical data were obtained from patients undergoing colonoscopy in Ruijin Hospital(North Branch),Shanghai Jiao Tong University School of Medicine from Jan.2012 to Dec.2017.To collect the age,sex,advanced colorectal adenomatous polyp numbers,size,morphology,position,and bowel preparation of patients with ACA,and to understand the characteristics of ACA in young and eldly patients,and the factors associated with missed diagnosis and recurrence in advanced colorectal adenomatous polyps.Results In missed diagnosis of young ACA,gender and bowel preparation were statistically significant(P<0.05).Males and those with poor bowel preparation were prone to missed diagnosis(P=0.001,P=0.000),but there was no statistical difference in the number of ACAs,size and position(P>0.05).There was a statistically significant difference in gender among recurrent young ACA(P=0.005).In elderly patients with missed diagnosis of ACA,males,multiple ACAs,flat or wide pediatric colorectal ACAs,and poor bowel preparation were more likely to miss diagnosis(P=0.002,P=0.023,P=0.001,P=0.000).The size and position of ACAs were not statistically significant(P>0.05).In recurrent elderly ACA,as in the young ACA,there was a statistical difference in gender(P=0.040),but there was no statistical difference in the number of ACAs,advanced colorectal adenomatous polyp size,morphology,position,and bowel preparation(P>0.05).Logistic regression analysis was performed on the factors related to missed diagnosis and recurrence of ACAs.The age(OR=0.608,P=0.007),gender(OR=2.553,P=0.000)and Boston score(OR=0.464,P=0.000)were independent risk factors for the diagnosis of ACAs.The gender(OR=1.589,P=0.018)was an independent risk factor affecting the recurrence of polyps.Conclusion Older age,males,and poor bowel preparation can lead to missed diagnosis of ACA,and males have a higher risk of recurrence.