高分辨率显微内镜诊断结肠息肉的学习曲线研究  

A study of learning curve for high resolution microendoscopy in diagnosis of colon polyps

作　　者：谈涛[1] 屈亚威[1] 舒娟[1] 张玲[1] 刘敏黎 刘海峰[1] 

机构地区：[1]武警总医院消化内科,北京100039

出　　处：《武警医学》2016年第5期460-464,共5页Medical Journal of the Chinese People's Armed Police Force

基　　金：首都临床特色应用研究(NO.Z141107002514099)

摘　　要：目的探讨高分辨率显微内镜(high resolution microendoscopy,HRME)下结肠息肉诊断的学习曲线。方法选择140例结肠息肉活检标本为研究对象,在前期制定的结肠息肉HRME诊断标准的基础上,回顾性分析其HRME图片特征。由一名经验丰富的HRME医师筛选出1张白光内镜图片和4张HRME图片,分别由3名观察者参与学习。在学习开始前,观察者需进行HRME基本知识和结肠息肉诊断标准的学习,并针对20例结肠息肉的HRME图片进行实例学习。然后再对120例标本的HRME图片进行4个阶段的学习,每个阶段完成后均做出HRME诊断,将HRME诊断结果与病理结果比较,计算观察者对结肠息肉的诊断效率,并评估HRME结果与病理结果之间的一致性。结果 4个阶段观察者诊断敏感性分别为72.2%、82.4%、94.4%和87.5%;特异性分别为75.0%、76.9%、91.7%和78.6%;准确性分别为73.3%、80.0%、93.3%和83.3%。前3个阶段之间相比,灵敏性、特异性及准确性差异均有统计学意义(均P<0.05);第4阶段与第3阶段相比,差异无统计学意义。4个阶段诊断一致性均较高,K值分别为0.63、0.75、0.89和0.81。结论 HRME是一种新的即时病理学诊断方法,对结肠息肉有较高的诊断价值。对初学者而言,HRME是一种简单而容易掌握的诊断技术,经过短期学习,可以获得较高的诊断率。Objective To study the learning curve for high resolution microendoscopy in diagnosis of colon polyps.Methods We selected 140 colon polyp biopsy specimens for the study,based on pre-established HRME diagnostic criteria for colon polyp,and retrospectively analyzed HRME photo features. An experienced HRME physician screened one white light endoscopic picture and four HRME pictures and three observers participated in learning,respectively. Before starting learning,observers needed to learn HRME basics and diagnostic criteria of colonic polyps for 20 cases of colon polyps. Then 120 specimens of HRME images were made to four stages of learning and observers made HRME diagnosis after each phase completed. HRME diagnostic results were compared with pathological findings,observer diagnostic efficiency of colon polyps was calculated to evaluate the consistency between HRME results and pathological findings. Results Four stages observers＇ diagnostic sensitivity was 72. 2%,82. 4%,94. 4% and 87. 5%;specificity was 75. 0%,76. 9%,91. 7% and 78. 6%,and accuracy was 73. 3%,80. 0%,93. 3% and 83. 3%. Compared with the first three stages,the differences of sensitivity,specificity and accuracy were statistically significant（ P〈0. 05）. Compared with the third stage,the difference was not statistically significant. Four stages had a higher diagnostic consistency,K values were 0. 63,0. 75,0. 89 and 0. 81. Conclusions HRME has a high diagnostic value for diagnosis of colon polyps as a new real-time pathology techinique. For beginners,HRME is a simple and easy to master diagnostic technique and one can get a higher diagnostic yield after a short time of learning.

关 键 词：高分辨率显微内镜 结肠息肉 诊断 学习曲线 

分 类 号：R730.49[医药卫生—肿瘤]