优化肠道再清洁联合白光或窄带成像内镜对结肠镜检查质量的影响  

Effects of optimized intestinal re-cleaning combined with white light or narrow-band imaging endoscopy on the quality of colonoscopy

作　　者：张园梦 邱烈旺[1] 刘刚[2] 何平[1] 黄剑[1] 曾波[1] ZHANG Yuan-meng;QIU Lie-wang;LIU Gang;HE Ping;HUANG Jian;ZENG Bo(System,Yongchuan Hospital Affiliated to Chongqing Medical University,Chongqing 402106,China)

机构地区：[1]重庆医科大学附属永川医院,402160 [2]自贡市第三人民医院,643020

出　　处：《现代消化及介入诊疗》2023年第2期168-172,176,共6页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：重庆医科大学附属永川医院院内课题(YJJC202110)。

摘　　要：目的探讨不同肠道再清洁时机下联合白光内镜或窄带成像内镜退镜观察对结肠镜检查质量的影响。方法采用单中心前瞻性随机对照试验,将2021年8月至2022年2月1083例门诊及住院结肠镜检查患者随机分为对照组(n=386)、WLI组(n=357)及NBI组(n=340)。对照组:常规进镜,退镜时再清洁,主要采用白光内镜(WLI)观察;WLI组:进镜时再清洁,退镜时主要采用白光内镜(WLI)观察;NBI组:进镜时再清洁,退镜时主要采用窄带成像内镜(NBI)观察。记录并比较三组患者的息肉检出率、进退镜时间、总镜检时间及BBPS等指标。同时将各组按末次肠道清洁剂服用时间至镜检开始时间的时间间隔分为短间隔组(3~5小时)和长间隔组(>5小时)两个亚组,进行亚组分析。结果研究发现试验组息肉检出率(WLI组44.8%、NBI组51.8%)显著高于对照组(38.1%)(P<0.05),试验组进镜时间(WLI组4.25±0.81 min、NBI组4.37±0.95 min)长于对照组(3.22±0.93 min)(P<0.05),试验组退镜时间(WLI组5.21±2.41 min、NBI组5.26±1.75 min)短于对照组(5.85±1.04 min)(P<0.05),总镜检时间两组无显著差异(P>0.05)。试验组退镜时各肠段肠道清洁度评分亦显著高于对照组(P<0.05)。亚组分析显示,当时间间隔为3~5小时时,对照组与WLI组的息肉检出率无显著差异(38.4%vs 45.3%P>0.05),而NBI组的息肉检出率高于对照组(50.9%vs 38.4%P<0.05)。在时间间隔大于5小时时,WLI组的息肉检出率高于对照组(43.2%vs 33.2%P<0.05),且NBI组的息肉检出率高于WLI组(53.9%vs 43.2%P<0.05)。结论改变结肠镜再清洁时机联合白光内镜或窄带成像内镜退镜观察,可提高息肉检出率,而总镜检时间不受影响。Objective To observe the effect of combined white light endoscopy or narrow-band imaging endoscopy during withdrawal observation on colonoscopy quality under different bowel re-cleaning timings.Methods A single-center prospective randomized controlled trial was designed.From August 2021 to February 2022,1083 outpatient and inpatient colonoscopy patients were randomly divided into control group(n=386),trial group A(n=357)and trial group B(n=340).Control group:routinely entered the endoscope,re-cleaned the colon when withdrawal,and observed mainly with white light endoscopy(WLI).trial group A:re-cleaned the colon when inserting the endoscope,and mainly observed with white light endoscopy(WLI)when withdrawing the endoscope;trial group B:re-cleaned the colon when inserting the endoscope,and mainly observed with narrow-band imaging endoscopy(WLI)when withdrawing the endoscope.The polyp detection rate,time of insertion and withdrawal,total time of endoscopic examination and BBPS were recorded and compared among the three groups of patients.According to the time interval(TI)from the last bowel cleansing agent administration time to the start of colonoscopy,each group was divided into two subgroups,short TI(3-5 hours)and long TI(>5 hours),and subgroup analysis was performed.Results The detection rates of polyps in the trial group(44.8%in group A and 51.8%in group B)were significantly higher than that in the control group(38.1%,P<0.05).The time of entering the colonoscopy in the trial group(4.25±0.81 min in group A,4.37±0.95 min in group B)was longer than that in the control group(3.22±0.93 min)(P<0.05),and the time of withdrawing the colonoscopy in the trial group(5.21±2.41 min in group A and 4.37±0.95 min in group B)5.26±1.75 min)was shorter than that of the control group(5.85±1.04 min)(P<0.05).There was no significant difference in the total colonoscopy examination time between the trial groups(9.47±2.89 min in group A and 9.58±2.23 min in group B)and the control group(9.06±1.39 min)(P>0.05).The intestinal cl

关 键 词：结肠镜检查质量 肠道清洁度 窄带成像内镜 息肉检出率 

分 类 号：R57[医药卫生—消化系统]