结肠镜用于左、右半结肠大肠腺瘤的检出率观察及影响因素研究

A study on the detection rate of colorectal adenomas in the left and right hemicolectomes and the factors influencing their detection

目的:研究结肠镜用于左、右半结肠大肠腺瘤的检出率及其影响因素。方法:回顾性分析2016年6月~2021年6月我院收治的86例行两次结肠镜检查患者的临床资料,比较两次检查结果,若第二次结肠镜检查结果表明存在新发现腺瘤且新发腺瘤不在初次检查切除腺瘤部位,则定义为漏检,分为漏检组(n=26)、检出组(n=60)。比较两组患者性别、年龄、2次结肠镜检查间隔时间、腹部/盆腔手术史、家族遗传史、腺瘤形态、结肠憩室、腺瘤部位、腺瘤病理、瘤变级别、麻醉、收缩压、舒张压、身体质量指数、肠道准备、腺瘤大小、平均进镜时间、平均退镜时间等,通过ROC分析腺瘤大小、平均进镜时间、平均退镜时间预测大肠腺瘤漏检价值,并采用多因素Logistic回归分析明确大肠腺瘤漏检的危险因素。结果:两组患者性别、年龄、腹部/盆腔手术史、家族遗传史、腺瘤形态、结肠憩室、腺瘤部位、腺瘤病理、瘤变级别、麻醉、收缩压、舒张压、身体质量指数比较差异无统计学意义。漏检组肠道准备差患者占比显著高于检出组,腺瘤大小显著小于检出组,平均进镜时间、平均退镜时间显著短于检出组,差异有统计学意义;经ROC分析,腺瘤大小≤5.016mm、平均进镜时间≤10.854min、平均退镜时间≤5.216min是大肠腺瘤漏检的最佳截断值;Logistic回归分析显示腺瘤大小≤5.016mm、平均进镜时间≤10.854min、平均退镜时间≤5.216min、肠道准备差是大肠腺瘤漏检的危险因素。结论:大肠腺瘤漏检与腺瘤大小、进镜时间、退镜时间及肠道准备有关。

Objective To study the detection rate of colonoscopy for left and right hemicolectomy for colorectal adenoma and its influencing factors.Methods We analyzed the clinical data of 86 patients who underwent colonoscopy twice from June 2016 to June 2021.comparing two test results,if the second colonoscopy results show that there are new found adenoma and new hair adenoma is not first time check,resected adenoma part is defined as the testers,divided into residual group (n=26),check out the group (n=60).Compare two groups of patients with gender,age,2 times a colonoscopy time interval,abdominal/pelvic surgery history,family history,adenoma,colonic diverticulum and adenoma,level of adenoma pathology,neoplasia,anesthesia,systolic pressure,diastolic blood pressure,body mass index (BMI),bowel preparation,adenoma size,average time,average mirror back into the mirror,etc.,The value of missed detection of colorectal adenoma was predicted by ROC analysis of adenoma size,mean entry time and mean exit time,and risk factors of missed detection of colorectal adenoma were determined by multivariate Logistic regression analysis.Results Two groups of gender,age,abdominal/pelvic surgery history,family history,adenoma,colonic diverticulum and adenoma,level of adenoma pathology,neoplasia,anesthesia,systolic pressure,diastolic blood pressure,body mass index there was no statistical significance.The residual group patients had a significantly higher proportion detection for intestinal preparation group,adenoma size was significantly less than detection group,The mean entry time and mean exit time were significantly shorter than those in the detection group,and the differences were statistically significant.According to ROC analysis,adenoma size ≤5.016mm,mean endoscopy time ≤10.854min,mean endoscopy time ≤5.216min were the best truncation values for missed detection of colorectal adenoma.Logistic regression analysis showed that adenoma size ≤5.016mm,mean entry time ≤10.854min,mean exit time ≤5.216min,and poor intestinal preparation were the risk factors for missed detection of colorectal adenoma.Conclusion Missed detection of colorectal adenomas was associated with adenoma size,time to scope,time to exit,mode of operation,and bowel preparation.