常规电子结肠镜检查中结肠息肉漏诊分析  

Analysis of colonic miss polyps by routine video colonscopy

作　　者：何晋德[1] 王怀堂[1] 刘玉兰[1] 朱元民[1] 

机构地区：[1]北京大学人民医院消化科,100044

出　　处：《中华消化内镜杂志》2007年第5期354-356,共3页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨常规电子结肠镜检查中结肠息肉的漏诊情况,包括漏诊率、漏诊息肉大小、分型、部位和病理状况。方法回顾3年间在120 d 内接受多次结肠镜检查的结肠息肉患者的病例资料,记录患者前2次肠镜检查的息肉数,漏诊息肉数,计算漏诊率。结果符合要求的患者共143例,男92例,女51例,年龄23～82岁;漏诊息肉数共126枚,漏诊率22.5%;在漏诊的息肉中,<5mm、5～9 mm 和≥10 mm 息肉分别占80.2%、18.3%和1.6%,各项间比较差异有统计学意义(P<0.01);山田Ⅰ、Ⅱ、Ⅲ和Ⅳ型息肉分别占87.3%、8.7%、3.2%和0.8%,各项间比较差异有统计学意义(P<0.01);直肠、乙状结肠、降结肠、横结肠、肝曲、升结肠和盲肠分别占11.1%、27.0%、12.7%、19.1%、10.3%、15.1%和4.8%,各项间比较差异有统计学意义(P<0.01);漏诊的晚期腺瘤在漏诊的腺瘤性息肉中占14.8%;漏诊息肉数与基础息肉数间相关分析显示有显著的相关性(r=0.674,P<0.01)。结论常规电子结肠镜检查中结肠息肉有较高的漏诊率,各段结肠间漏诊率不同,且漏诊息肉绝大多数为<5 mm 的Ⅰ型息肉。患者罹患息肉越多,漏诊越多。Objective To explore miss rate of colonic polyps by routine video colonoscopy and size, type, location, and pathologic features of missed polyps. Methods We retrospectively analyzed the colonic polyps patients who were examined by tandem video colonoscopies within 120 days in the past 3 years from 2004 to 2006. Number of Miss polyps（NMP） equals to polyps found by the second examination（PFS） which minus polyps left in the fimt colonoscopy（PLF）. The number of basal polyps（NBP） equals to polyps found in the fimt colonscopy which plus NMP. Miss rate equals to NMP/NBP × 100%. Results There were 143 patients, age 63.0 ± 12.6（23 -82）years old, 92 of them were men. NMP was 126 and miss rate was 22. 5%. Among missed polyps, proportions of 〈 5mm, 5 -9mm and ≥ 10mm in diameter were 80. 2% , 18. 3% and 1.6% respectively, presented a significant difference（ P 〈 0.01 ） ; type Ⅰ , Ⅱ, Ⅲ and Ⅳ were 87.3% , 8.7% , 3.2% and 0. 8% respectively, the difference was significant （ P 〈 0.01 ）. Miss rates were different in different segment of colon （P 〈0. 01 ）, rectum, sigmoid, descending, transverse, hepatic flexure, ascending and cecum were 11.1% , 27.0% , 12. 7% , 19. 1% , 10. 3% , 15.1% and 4. 8% respectively. Missed advanced adenoma was 14. 8% in all missed adenomas. There was significant positive correlation between NMP and NBP（ r = 0. 674, P 〈 0. 01 ）. Conclusion The miss rate of colonic polyps is 22. 5 % by routine video colonoscopy. The most of missed polyps is 〈Smm in size and type Ⅰ ones. Different segment of colon has different miss rate. The more basal polyps were, the more missed polyps were.

关 键 词：结肠镜检查 结肠息肉 漏诊 

分 类 号：R574.62[医药卫生—消化系统]