肠道准备末次排便时间对结肠镜检查质量的影响  

Relationship Between Last Defecation Time of Bowel Preparation and Quality of Colonoscopy

作　　者：陈栩槿 周梁云 韦冰妮[1,3] 许冰心 张小雪 纪璘 杨成 占强[1,3] CHEN Xujin;ZHOU Liangyun;WEI Bingni;XU Bingxin;ZHANG Xiaoxue;JI Lin;YANG Cheng;ZHAN Qiang(Department of Gastroenterology,the Affiliated Wuxi People′s Hospital of Nanjing Medical University,Wuxi,Jiangsu Province,214023;Digestive Endoscopy Center,the Affiliated Wuxi People′s Hospital of Nanjing Medical University,Wuxi,Jiangsu Province,214023;Wuxi Medical Center of Nanjing Medical University,Jiangsu Branch of the National Clinical Research Center for Digestive Diseases,Wuxi,Jiangsu Province)

机构地区：[1]南京医科大学附属无锡人民医院消化内科,214023 [2]南京医科大学附属无锡人民医院消化内镜中心,214023 [3]南京医科大学无锡医学中心,国家消化系统疾病临床研究中心(西安)江苏省分中心

出　　处：《胃肠病学》2024年第7期385-390,共6页Chinese Journal of Gastroenterology

基　　金：江苏省基础研究计划(BK20231146);南京医科大学无锡医学中心2023年重点项目(WMCM202305);南京医科大学无锡医学中心专病队列项目(WXKY202302010)。

摘　　要：背景:结肠镜检查是诊断结直肠癌的金标准,而高质量的肠道准备是结肠镜检查的关键。目的:探讨结肠镜检查患者服完泻药后末次排便至检查开始的时间间隔对肠道准备和结肠镜检查质量的影响。方法:本研究为多中心横断面研究。连续纳入江苏省5个研究中心2023年6月—2023年12月在门诊接受无痛结肠镜检查且符合标准的患者,根据末次排便至结肠镜检查开始的时间间隔分为A、B、C三组,时间间隔分别为≤2 h、2~5 h和≥5 h。主要结局指标为波士顿肠道准备量表(BBPS)评分,次要结局指标包括进镜时间、退镜时间、进镜距离和腺瘤/息肉检出率。结果:共298例接受无痛结肠镜检查的患者纳入研究。3组患者性别、年龄、体质指数、腹围、疾病史、手术史等基线特征差异无统计学意义。A、B、C组BBPS总分依次降低,分别为8.27±0.58、8.21±0.53和8.05±0.37,总体差异有统计学意义(P<0.05);分肠段分析显示3组间仅右半结肠清洁度总体差异有统计学意义(2.48±0.50、2.40±0.49和2.18±0.39, P<0.05)。3组进镜、退镜时间和进镜距离无明显差异,腺瘤检出率分别为45.2%、57.5%和35.4%,息肉检出率分别为53.4%、63.8%和43.1%,总体差异有统计学意义(P均<0.05)。结论:结肠镜检查肠道准备末次排便至检查开始的时间间隔控制在5 h以内可获得较好的肠道准备质量和更高的腺瘤/息肉检出率。Background:Colonoscopy is the gold standard for diagnosis of colorectal cancer,and the success of colonoscopy is highly depended on the quality of bowel preparation.Aims:To investigate the impact of the last defecation time before colonoscopy on qualities of bowel preparation and colonoscopy.Methods:Consecutive outpatients who underwent painless colonoscopy from June 2023 to December 2023 at 5 medical centers in Jiangsu Province and met the inclusion criteria were enrolled in this multicenter cross-sectional study.These patients were divided into 3 groups according to the time interval between the last defecation and the start of colonoscopy.The time interval was≤2 h,2-5 h,and≥5 h in group A,B,and C,respectively.The primary outcome was the score of the Boston Bowel Preparation Scale(BBPS),and the secondary outcomes included the cecal intubation time(CIT),withdrawal time(WT),cecal intubation length(CIL),adenoma detection rate(ADR),and polyp detection rate(PDR).Results:A total of 298 patients underwent painless colonoscopy were enrolled in the study.There were no significant differences in gender,age,body mass index,abdominal circumference,comorbidities,surgical histories,and other baseline data among the three groups.The total BBPS score declined gradually from 8.27±0.58 in group A to 8.21±0.53 in group B and 8.05±0.37 in group C(P<0.05).Segment-specific analysis showed that significant difference in bowel cleanliness only existed in right colon among the three groups(BBPS score:2.48±0.50,2.40±0.49,and 2.18±0.39,respectively,P<0.05).There were no significant differences in CIT,WT and CIL among the three groups,while the highest ADR and PDR were seen in group B(ADR:45.2%,57.5%,and 35.4%,respectively,P<0.05;PDR:53.4%,63.8%, and 43.1%, respectively, P<0.05). Conclusions: When the time interval between the last defecation and the start ofcolonoscopy is less than 5 h, more effective bowel preparation and higher ADR and PDR can be achieved.

关 键 词：结肠镜检查 肠道准备 末次排便时间 腺瘤检出率 息肉检出率 

分 类 号：R73[医药卫生—肿瘤]