结肠镜检查困难程度的患者相关因素分析

Analysis of Patient⁃related Factors Affecting Difficulty of Colonoscopy

背景:完整的结肠镜检查是诊断和治疗结直肠疾病的关键,其在降低结直肠癌发病率和死亡率方面的作用已得到公认。目的:分析影响结肠镜检查困难程度的患者相关因素。方法:通过专家咨询,对可能影响结肠镜检查困难程度的患者相关因素以Likert量表进行排序。采用回顾性研究设计,连续纳入2021年1月—2022年1月在南京医科大学附属无锡人民医院门诊行无痛结肠镜检查且符合条件的患者1621例,收集人口学、临床和内镜相关资料,主要结局指标包括盲肠插入时间(CIT)和腺瘤/息肉检出率。采用多因素Logistic回归模型分析困难结肠镜检查(CIT≥10 min)的独立危险因素。结果:1621例结肠镜检查患者中45.8%为男性,平均年龄(47.45±13.27)岁,平均体质指数(23.32±3.11)kg/m^(2)。将2轮专家咨询筛选出的排名前5的可能影响结肠镜检查困难程度的患者因素纳入单因素和多因素分析。多因素Logistic回归分析显示,既往妇科手术史(OR=14.895,95%CI:9.741~22.776,P<0.001)、女性(OR=3.086,95%CI:2.066~4.608,P<0.001)、年龄≥60岁(OR=2.890,95%CI:1.957~4.269,P<0.001)和便秘20~30年(OR=1.804,95%CI:1.021~3.185,P<0.05)是困难结肠镜检查的独立危险因素,这些因素对腺瘤/息肉检出率也有显著影响。结论:既往妇科手术史、女性、高龄、长期便秘是困难结肠镜检查的患者相关独立危险因素,临床实践中对这些因素进行综合考虑有助于预判结肠镜检查困难程度。

Background:Complete colonoscopy is crucial for the diagnosis and treatment of colorectal diseases,its role in reducing the morbidity and mortality of colorectal cancer has been well recognized.Aims:To identify the patient-related factors that influenced the difficulty of colonoscopy.Methods:Firstly,patient-related factors that might affect the difficulty of colonoscopy were proposed and ranked by Likert method through expert consultation.A total of 1621 consecutive and eligible outpatients undergoing painless colonoscopy from January 2021 to January 2022 at the Affiliated Wuxi People´s Hospital of Nanjing Medical University were evaluated in a retrospective study.The demographic,clinical and endoscopic data were collected.The primary outcomes were cecal insertion time(CIT)and adenoma/polyp detection rates.The independent risk factors for difficult colonoscopy(CIT≥10 min)were analyzed by using multivariate Logistic regression model.Results:The mean age of 1621 cases of patients was(47.45±13.27)years,of which 45.8%were males and the mean body mass index was(23.32±3.11)kg/m^(2).Based on 2 rounds of expert consultation,the top five patient-related factors affecting the difficulty of colonoscopy were enrolled in the univariate and multivariate analyses.Multivariate Logistic regression analysis revealed that history of gynecological surgery(OR=14.895,95%CI:9.741-22.776,P<0.001),female gender(OR=3.086,95%CI:2.066-4.608,P<0.001),age≥60 years(OR=2.890,95%CI:1.957-4.269,P<0.001),and constipation for 20-30 years(OR=1.804,95%CI:1.021-3.185,P<0.05)were independent risk factors for difficult colonoscopy.Meanwhile,these four factors were also associated with adenoma/polyp detection rates.Conclusions:History of gynecological surgery,female gender,advanced age,and long-term constipation are patient-related independent risk factors for difficult colonoscopy.Comprehensive consideration of these factors may helpful for predicting the difficulty of colonoscopy in clinical practice.