大肠息肉内镜漏诊及其相关因素分析  

Missed diagnosis of colonic polyps with colonoscopy and its related factors

作　　者：楼国春[1] 杨建民[1] 柯进晶[1] 徐启顺[1] 吴伟权[1] 

机构地区：[1]浙江省人民医院消化内科,杭州310014

出　　处：《浙江医学》2014年第2期98-101,共4页Zhejiang Medical Journal

摘　　要：目的：了解电子结肠镜检查的息肉漏诊情况，分析漏诊息肉的内镜和病理特点，并探讨息肉漏诊的影响因素。方法回顾近两年来接受2次或以上电子肠镜检查（间隔时间不超过180d）的患者资料，分析息肉漏诊率，漏诊息肉的内镜和病理学特点及其影响因素。结果178例符合条件的患者中，基础息肉314颗，漏诊息肉87颗，息肉漏诊率为27.7％。漏诊息肉中直径＜5、5～＜10、≥10mm者分别为55.2%，32.2%，12.6%；Ip型、Isp型、Is型、II型息肉分别为：4.6％、17.2％、75.9％、2.3％；漏诊息肉的部位：直肠21.8％，乙状结肠41.4％，降结肠5.7％，脾曲0%，横结肠17.2％，肝曲1.1％，升结肠11.5％，回盲部1.1％；漏诊息肉中，肿瘤性息肉占64.0%，直径≥1cm、含有绒毛状成分或有高度异型增生3者之一的腺瘤占所有漏诊息肉的11.5％。息肉漏诊率与结肠镜的操作方法（单人法和双人法）、操作者的年资和结肠镜操作熟练程度，都不存在统计学相关。漏诊息肉数和基础息肉数明显相关（r=0.694， P＜0.01）。结论大肠息肉的漏诊在电子结肠镜检查中非常普遍。直径＜5 mm、Is型的大肠息肉漏诊率最高。息肉漏诊最常见发生于直肠、乙状结肠和横结肠。漏诊息肉数和基础息肉数明显相关。Objective To review the missed diagnosis of colonic polyps with endoscopy and the related factors. Methods One hundred and seventy eight patients received electronic colonoscopy twice with an interval of 180d. The pathological features of basal and missed colon polyps were reviewed and the related factors were analyzed. Results The mean interval of two colonoscopic examination was 46.7＆#177;49.0 d. Total 314 basal polyps were found in 178 patients, and 87 polyps missed in 67 pa-tients with a miss rate of 27.7%. The missed polyps of〈5mm, 5~〈10mm and≥10 mm in diameter accounted for 55.2%,32.2%and 12.6%, respectively. Polyps of type Ip, Isp, Is and II were 4.6%, 17.2%, 75.9%and 2.3%, respectively;missed polyps in the rectum, sigmoid, descending colon, splenic flexure, transverse colon, hepatic flexure, ascending colon and cecum were 21.8%, 41.4%, 5.7%, 0%, 17.2%, 1.1%, 11.5%and 1.1%;and the missing rate of advanced polyps accounted for 11.5%. No significant correlation was found between the miss rate and procedure of colonoscopy（singleperson vs two- person, P＆gt;0.05） , neither be-tween the miss rate and operators （P〉0.05）. The number of basal polyps was significantly correlated with the number of missed polyps （r=0.694, P〈0.01）. Conclusion Routine white- light colonoscopy has a high missing rate of colonic polyps. Polyps of〈5 mm in diameter or type Is seem to be more likely to be missed. Most of missed polyps locate in the rectum, sigmoid and trans-verse colon. More basal polyps usual y accompany with more missed polyps.

关 键 词：结肠镜 结肠息肉 漏诊 

分 类 号：R735.34[医药卫生—肿瘤]