结直肠息肉漏诊的多中心回顾性分析  

A multi-center and retrospective analysis of missed diagnosis of colorectal polyps

作　　者：吴进峰[1] 余细球[1] 陈科云[1] 范东俊[1] 吴建维[2] 郭玉庆[2] 黄旭明 杨光朝 刘锦涛[2] 

机构地区：[1]深圳市第五人民医院消化内科,518109 [2]深圳市第八人民医院消化内科 [3]深圳市石岩人民医院消化内科

出　　处：《中华消化内镜杂志》2017年第5期318-321,共4页Chinese Journal of Digestive Endoscopy

基　　金：广东省医学科研基金项目（A2014512）;深圳市科技研发资金基础研究项目（JCYJ20160427191926655）

摘　　要：目的探讨结肠镜检查中息肉的漏诊情况并筛选其危险因素。方法纳入近3年来深圳市3家消化内镜中心检查发现息肉后3个月内收入院再次肠镜检查并行肠镜下息肉切除者655例，计算其息肉患者漏诊率及患者息肉漏诊率，分析漏诊率与患者性别、年龄、症状、基础息肉数及息肉大小、形态、部位诸因素之间的关系。结果655例患者共发现息肉1783枚，其中224例（34．20％，224／655）漏诊息肉共459枚（20．47％，459／2242）。基础息肉数从1枚增加到4枚时漏诊率呈逐渐增加的趋势，但差异无统计学意义，基础息肉数≥5是患者发生息肉漏诊的独立危险因素（OR=4．98，P=0．00），男性比女性更易发生漏诊（OR=1．76，P=0．00）。直径〈5mm（OR=2．94，P=0．00），扁平外型即山田分型I（OR=2．72，P=0．01）、II（OR=3．23，P=0．00）亦是息肉易于被漏诊的独立危险因素。结论结直肠息肉在肠镜检查中存在一定程度的漏诊，漏诊率与性别、基础息肉数及息肉大小、形态有关，男性、多发息肉患者更易发生漏诊，小的扁平息肉易被漏诊。Objective To study the missed diagnosis of colorectal polyps during colonoscopy and its risk factors. Methods Data of 655 patients who underwent repeated colonoscopy in 3 months （90 days） were analyzed in three endoscopy centers in Shenzhen. Miss rates of polyps and patients were calculated. Logistic regression analysis was used to identify the suspected risk factors associated with the miss rate including gender, age, symptoms of patient and number, shape, location of polyps. Results A total of 459 polyps（20. 47%, 459/2 242） in 224 patients （ 34. 20%, 204/655 ） were missed in overall 1 783 polyps within 655 patients. The patient miss rate increased with the polyp count increasing from 1 to 4, but with no significant differences. Polyp count of more than 5 was the independent risk factor for patient miss rate during colouoscopy（ OR=4. 98,P=0. 00）. Polyps in males were easier to be missed than those in females （OR = 1.76, P = 0.00 ）. Size less than 5 mm was the independent risk factor for missed diagnosis during colonoseopy（ OR= 2. 94,P= 0. 00）. The flat type（ Yamada I, II ） was also the independent risk factor（ OR= 2.72,P=0. 01;OR=3.23, P=0.00 respectively）. Conclusion The miss rate of polyps is related to gender, basic polyp count, the size and shape of polyp. Male with muhiple polyps and polyps with flat type and small size tend to be missed.

关 键 词：结直肠息肉 结肠镜检查 漏诊率 

分 类 号：R574[医药卫生—消化系统]