结肠多发息肉漏诊相关因素分析

目的探讨结肠镜检查中结肠多发息肉漏诊相关因素。方法回顾性分析2021年7月至2022年6月首次肠镜检查发现息肉,并3个月内再次行肠镜诊治并有新息肉发现患者的临床资料,统计分析相关漏诊因素(大小、部位、形态及病理性质、肠道清洁度,医师经验,是否麻醉状态,退镜时间)。结果226例患者共751枚息肉,第一次肠镜检查发现腺瘤性息肉、非肿瘤性息肉(炎性或增生性息肉)分别为304枚、105枚;第二次肠镜检查分别为212枚、130枚;腺瘤漏诊率28.23%,息肉总漏诊率45.54%。单因素分析显示,小息肉、无蒂息肉、非肿瘤性息肉、初级医师经验、非麻醉状态、退镜时间短存在较高漏诊率(P<0.05)。多因素分析显示,息肉小、短医师经验、退镜时间短为漏诊的独立危险因素(P<0.05)。结论结肠多发息肉易漏诊,小息肉漏诊率高;医师经验较高、延长退镜时间可降低息肉漏诊率。

Objective To explore the factors affecting the detection rate of colorectal multiple polyps in colonoscopy.Methods We reviewed the medical records of patients who were found to have colorectal polyps at the first colonoscopy and received second colonoscopy within 3 months in our hospital between July 2021 and June 2022.The objective factors in colonoscopy(the degree of intestinal cleaning,retraction time,endoscopic experience and endoscopic mode of operation)and polyps characteristics(the size,shape,location and pathological types)detected in the selected patients were compared between the two examinations.Results Total of 226 cases with 751 polyps were selected,there were 304 adenomatous polyps and 105 hyperplastic polyps in the first colonoscopy.The corresponding numbers were 212 and 130 in the second colonoscopy,the adenomas miss rate was 28.23%,and the polyps miss rate was 45.54%.A relatively high missed rate could be happened in small polyps(≤5 mm),stepless polyps,hyperplastic polyps,poor endoscopic experience,short retraction time and non-anesthesia(P<0.05),and low missed rates in polyps location and the degree of intestinal cleaning(P>0.05).Logistic regression analysis showed that the size of polyps,endoscopic experience,and retraction time were independent factors(P<0.05).Conclusion There is a significant miss rate for colorectal multiple polyps,the miss rates of small polyps were higher,rich endoscopic experience and long retraction time can reduce miss rate.