色素放大结肠镜诊断结直肠隆起性病变的临床应用

目的 探讨色素放大结直肠镜结合Kudo分型在诊断结直肠病变中的临床应用价值。方法 对125例病人行常规内镜诊断后，对结直肠新生儿进行染色并结合Kudo分型作出色素放大内镜诊断，取标本作病理检查，将仙和色素放大内镜诊断结果与病理诊断结果相比较，观察符合率。结果 在125例病灶中，普通内镜下诊断为炎性息肉，管状腺瘤，绒毛状腺瘤和结直肠癌的病理符合率分别为：95．6％，80．0％，90．0％和100％，总病理符合率为85．6％；色素放大内镜诊断的病理经分别为100．0％，93．8％，99％和100．0％，总病理经为95．2％。结论 色素放大结肠镜对判断结直肠病变的性质有较高的病理符合率，并能有效提高微小，表浅隆起型病灶的检出率，具有较高临床应用价值。     

CT仿真结肠镜在结直肠病变诊断中的应用价值

目的探讨评估CT仿真结肠镜(CT Virtual Colonscopy,CTVC)在结肠息肉、结肠癌、溃疡性结肠炎、结肠黑变病中的检出能力，初步评阶其在结直肠病灶中的临床应用前景。方法对44例病人行CTVC检查，并与全结肠镜、病理结果进行对比研究。结果CTVC对结肠癌、结肠息肉具有较高辨别力，成功检出了全部10例结肠癌，并得到病理证实。10mm以上结直肠息肉CTVC与结肠镜都做出了正确诊断，CTVC发现5～10mm息肉14枚，＜5mm息肉CTVC仅发现2枚；CCTV发现2例。溃疡性结肠炎，结肠黑变病未检出。结论CTVC在结直肠癌和＞5mm以上结直肠息肉样病变诊断上具有较高的临床应用价值。     

窄带成像技术在结直肠肿瘤性与非肿瘤性病变诊断中的临床应用价值

目的探讨内镜窄带成像技术(NBI)在结直肠肿瘤性及非肿瘤性病变诊断中的临床价值.方法选择2010年2月至2011年3月常规结肠镜检查发现的结直肠肿瘤性与非肿瘤性病变75个(60例).发现病变后分别采用常规模式、NBI模式及染色方法对病变轮廓、黏膜表面腺管开口(PIT)及微血管(CP)形态进行观察,与病理检查结果进行对比...     

CT仿真内窥镜与超声造影对结直肠癌的诊断价值

目的评价CT仿真内窥镜（CTVE）和超声造影（CEUS）在结直肠癌诊断中的价值。方法对30例结直肠癌患者术前进行CTVE和CEUS检查,将二者结果与手术后的病理结果对比。结果CTVE对结直肠癌的诊断准确率96．67％（29／30）,CEUS对结直肠癌的诊断准确率为90％（27／30）。结论CTVE和CEUS可以准确显示结直肠癌病灶,有助于结直肠癌的准确诊断。     

JNET分型在结直肠肿瘤性病变诊断中的价值

目的 评估窄带成像放大内镜（ME-NBI）下应用JNET分型诊断结直肠肿瘤性病变的临床价值。方法 在ME-NBI模式下对结肠镜检查发现的110处结直肠新生性病变进行观察,分析病变的血管形态及表面结构变化,根据ME-NBI分型系统（JNET分型、Kudo分型）初步判断病变的性质,并与切除标本的病理结果进行对比分析。结果 ME-NBI下JNET分型总体分型诊断结直肠肿瘤性病变的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为96.2%（75/78）、93.8%（30/32）、97.4%（75/77）、90.9%（30/33）和95.5%（105/110）,Kudo分型总体分型的上述指标结果分别为92.3%（72/78）、81.3%（26/32）、92.3%（72/78）、81.3%（26/32）和89.1%（98/110）,两者在诊断准确率上差异无统计学意义（P=0.077）。JNET分型总体分型诊断微小息肉（≤0.5 cm）、小息肉（＞0.5～1.0 cm）、大息肉（＞1.0 cm）肿瘤性的准确率分别为92.3%（36/39）、93.8%（15/16）和98.2%（54/55）,三者间差异无统计学意义（P=0.379）。结论 ME-NBI下JNET分型在鉴别结直肠病变肿瘤性与非肿瘤性方面具有较可靠的诊断价值。     

窄带成像内镜技术在结直肠病变诊断中的应用

结直肠肿瘤的发病率和死亡率近年呈明显上升的趋势,因此早期诊断和治疗结直肠肿瘤显得十分重要。窄带成像内镜技术作为一种新的内镜下诊断技术,已初步显示出其对结直肠病变的诊断价值。本文就窄带成像内镜技术的原理及其诊断结直肠病变的作用作一综述。     

CT仿真结肠镜与电子结肠镜对结直肠疾病诊断的对照研究

目的探讨CT仿真结肠镜(CTVC)在结直肠疾病,尤其是溃疡性结肠炎诊断中的价值。方法应用螺旋CT对2004年5月至2005年1月就诊于首都医科大学附属北京友谊医院的58例疑诊结直肠病变患者进行容积扫描,获取仿真结肠镜图像,将所得结果与结肠镜结果进行比较分析。结果CTVC检查均获得成功,共检出结直肠癌14例,结直肠息肉15例,溃疡性结肠炎14例,正常者6例。CTVC对结直肠疾病总的敏感性为82.7%(43/52),特异性为100%,准确性为84.5%(49/58),阳性预测值87.8%(43/49),阴性预测值40.0%(6/15),Kappa值为0.497;CTVC对溃疡性结肠炎诊断的敏感性为70.0%(14/20),特异性为100%,准确性为76.9%(20/26),阳性预测值70.0%(14/20),阴性预测值50.0%(6/12),Kappa值为0.519。结论CTVC是一种无创的检查方法,具有一定优势,但仍存在一些弊端,因此对于溃疡性结肠炎诊断仅是一种有效的补充,尚不能完全替代常规结肠镜检查。     

结直肠癌筛查对结直肠肿瘤早期诊断的意义

背景：我国结直肠癌（CRC）发病率和死亡率呈上升趋势,发病年龄趋于年轻化。目的：分析CRC筛查初筛阳性人群的结肠镜检查结果,探讨高危问卷联合粪便隐血试验的CRC筛查模式对于结直肠肿瘤早期诊断的意义。方法：连续纳入2013年5月—2019年10月参与上海市黄浦区社区CRC筛查,因初筛结果阳性至瑞金医院卢湾分院接受结肠镜检查的高危个体,内镜检查发现病变者取活检或摘除送病理检查。同期因排便习惯改变行结肠镜检查的患者作为对照组。分析两组结直肠肿瘤检出情况以及筛查阳性组的病变特征。结果：共1 329例初筛阳性者纳入研究,结肠镜检查病变总体检出率为63.3%,CRC、息肉和腺瘤性息肉检出率分别为2.6%(34例)、60.7%(807例)和35.2%(468例),均显著高于对照组（n=22 438）的43.6%、1.8%、41.5%和21.6%(P均<0.05)。筛查阳性组病变检出率男性显著高于女性（73.7%对54.2%, P<0.05）,且随年龄增长呈增高趋势（P<0.05）。CRC主要分布于60～79岁年龄组,无性别分布差异,病变直径均≥1 cm;发生异型增生的腺瘤直径亦多≥...     

经肠镜微探头超声检查对结直肠黏膜下隆起病灶的诊断分析

目的 探讨经内镜微探头超声检查对结直肠黏膜下隆起病灶的诊断价值.方法 应用微探头对68例70处结直肠黏膜下隆起性病灶进行肠镜下超声检查,总结内镜超声特点,并与最终诊断比较.结果 发现类癌20例,表现为黏膜下层低回声;脂肪瘤12例,多位于右半结肠(11/12),表现为黏膜下层、边界清楚的强回声;囊肿12例,表现为黏膜下层的单房或多房性的无回声区,包膜完整;间质瘤或平滑肌瘤12例,多位于直肠9例,表现为黏膜肌层及以下各层次的均匀或不均匀低回声为主,外覆稍强回声包膜,两者在超声下很难区别;恶性淋巴瘤3例5个,表现为局部黏膜肌层和黏膜下层增厚,呈中低回声,不均匀,较少侵及固有肌层;血管性病变(血管瘤、静脉曲张)3个,表现为黏膜及黏膜下层的无回声,部分中、高回声,圆形或不规则形,散在或成族状分布,部分互相沟通;另外,还有子宫内膜异位2例,色素沉积1例,阑尾慢性脓肿1例,壁外压迫2例.超声与最终诊断结果均相符.结论 经内镜微探头超声检查可以明确大肠黏膜下隆起的大小、肠壁起源和边界.根据超声特征对黏膜下良恶性判别有一定的价值,同时能与腔外压迫性病变相鉴别.     

结直肠侧向发育型肿瘤伴结直肠息肉的临床特征初步分析

目的 结直肠侧向发育型肿瘤(laterally spreading tumors, LST)和结直肠息肉均被认为是结直肠癌(colorectal cancer, CRC)的癌前病变,且LST常常伴随结直肠息肉发生发展。探索LST伴结直肠息肉的临床特征。方法 对昆明医科大学第二附属医院2016年1月至2021年12月经结肠镜检查诊断为LST伴结直肠息肉95例,根据LST亚型、部位、大小、病理组织学各分为两组,进一步比较分析以上各组间在伴发结直肠息肉大小、部位、数量上的临床特征。结果 1. LST-NG伴单发结直肠息肉的比例高于LST-G组(54.5%vs. 22.6%)(P<0.05)。2. LST<3 cm伴<1 cm的结直肠息肉比例较高[(91.8%)vs.(50.0%)],LST≥3 cm伴有≥1 cm结直肠息肉比例高于LST<3 cm[(50.0%)vs.7(8.2%)](P<0.05)。3.近端结肠的LST多伴发近端结肠息肉(45.8%),远端结肠的LST多伴发远端结肠息肉(55.6%)(P<0.05)。4. LST恶性组和非恶性组在结直肠息...     

64层螺旋CT仿真结肠镜对结直肠占位性病变的筛选价值

目的 探讨64层螺旋CT仿真结肠镜（CTC）对结直肠占位性病变的筛选价值.方法 65例疑为结肠占位的患者,经肛门注气后行64层螺旋CT腹盆腔连续薄层扫描,应用64层螺旋CT仿真结肠镜软件对获取的数据进行三维仿真结肠镜图像重建,与结肠镜和临床病理结果进行对照分析.结果 结肠镜诊断结肠息肉患者36例共56枚息肉,CTC发现32例共45枚息肉,CTC结直肠息肉检出率为86.5％;结肠镜诊断结肠癌12例,CTC诊断结肠癌15例,能够显示结肠癌的大体分型、＞5.0mm的癌结节,能直观反映癌肿处肠壁及肠周受侵状况,对癌肿肠周受侵判断准确率较高.结论 CTC对结肠占位性病变是一种无创、有效的检查方法,可成为高危人群结肠肿瘤筛选的方法之一.     

Colonography by CT, MRI and PET/CT combined with conventional colonoscopy in colorectal cancer screening and staging

Colorectal cancer （CRC） remains a leading cancer killer worldwide. But the disease is both curable and preventable at an early stage. Regular CRC cancer screening has been shown to reduce the risk of dying from CRC. However, the importance of large-scale screening is only now starting to be appreciated. This article reviews a variety of imaging procedures available for detecting ulcerative colitis （UC） and Crohn＇s disease （CD）, polyps and CRC in their early stage and also presents details on various screening options. Detecting, staging and re-staging of patients with CRC also require multimodality, multistep imaging approaches. Staging and re-staging with conventional colonoscopy （CC）, computer tomography colonography （CTC）, magnetic resonance colonography （MRC） and positron emission tomography/computer tomography colonography （PET/CTC） are of paramount importance in determining the most appropriate therapeutic method and in predicting the risk of tumor recurrence and overall prognosis. The advantages and limitations of these modalities are also discussed.     

CT仿真结肠镜在老年患者中的临床应用

目的探讨CT仿真结肠镜在老年患者中的临床价值。方法 75例高度怀疑存在结直肠病变却不能耐受或不愿接受结肠镜检查的老年患者,进行CT仿真结肠镜检查。结果 CT仿真结肠镜显示存在阳性病变61例,包括肿瘤53例,其中16例患者最后得到了手术治疗,经手术及术后病理得到进一步证实;另有良性狭窄病变8例。8例良性病变及14例阴性结果病例中有11例在6个月后得到复查,病情均无明显进展。结论 CT仿真结肠镜对老年患者的结直肠病变诊断具有较高的临床价值,是结肠镜检查的重要补充。     

The diagnosis of colorectal cancer with cytologic brushings under direct vision at fiberoptic colonoscopy

Fifty nine cases of colorectal cancer confirmed postoperatively by histologic examination were correlated with the findings of biopsy specimens and cell brushings. Fifty one cases were positive for malignancy on biopsy (86.4 percent). Brush cytology was positive in 51 cases (86.4 percent). The total preoperative confirmed diagnostic rate of the series was 91.5 percent. Brushing cytology under direct vision at fiberoptic colonoscopy, is a safe, reliable, and quite accurate method for the diagnosis of colorectal cancer. The results from brush cytology did not relate to the configuration and appearance of the tumor. For cell brushing, the fluid in the colonic lumen should be aspirated off as throughly as possible. Cell brushings are often positive when colonic stricture and obstruction prevent the colonoscope from reaching the lesion; biopsy, obviously, cannot be done in such a case.     

Polyethylene glycol solution (PEG) plus contrast medium vs PEG alone preparation for CT colonography and conventional colonoscopy in preoperative colorectal cancer staging

Purpose This study evaluated the usefulness of combined polyethylene glycol solution plus contrast medium bowel preparation (PEG-C preparation) followed by dual-contrast computed tomography enema (DCCTE) and conventional colonoscopy. The main purpose of these examinations is the preoperative staging of already known tumors.Materials and methods One hundred patients with colorectal tumors were alternately allocated to either a polyethylene glycol solution preparation (PEG preparation) group (n=50) or a PEG-C preparation group (n=50) before undergoing conventional colonoscopy and computed tomographic (CT) colonography. After conventional colonoscopy, multidetector row CT scans were performed. Air images were reconstructed for both groups; contrast medium images were additionally reconstructed for the PEG-C preparation group. DCCTE images were a composite of air images and contrast medium images without use of dedicated electronic cleansing software. Quality scores (the presence or absence of blind spots of the colon) were compared between the two groups.Results Complete tumor images were obtained by DCCTE for all 50 (100%) lesions in the PEG-C preparation group, as compared with only nine of the 50 lesions (18%) in the PEG preparation group (air-contrast CT enema). The overall quality score in the PEG-C preparation group was significantly better than that in the PEG preparation group (P<0.0001).Conclusions DCCTE showed the entire colon without blind spots in nearly all patients in the PEG-C preparation group because the areas under residual fluid were reconstructed as contrast medium images. DCCTE and conventional colonoscopy after PEG-C preparation are feasible and safe procedures that can be used for preoperative evaluation in patients with colorectal cancer.     

肠镜用水温度对注水法肠镜影响的临床分析

目的探讨不同温度的肠镜检查用水对注水法肠镜的影响。 方法随机对照单盲研究，纳入2017年8月至2018年2月因体检行肠镜检查患者300例，随机分为三组：注气组100人；注室温水组（22 ℃）100人；注加热水组（38 ℃）100人。由三名内镜医生随机进行单人肠镜操作，记录腹痛评分、达回盲部时间、检查成功率、息肉的检出率、体位变化、腹部按压、肠镜检查满意度、退镜时间、诊断结果等数据。 结果注气组、注室温水组、注加热水组的三组患者的腹痛评分（5.5±4.0；3.0±2.0；3.0±1.0）、达回盲部时间（187.00±131.25 s；268.00±89.50 s；250±103.50 s）、退镜时间（137.5±62.00 s；156.50±76.25 s；156.00±67.00 s）、肠镜检查满意度（74%；87%；90%）有统计学差异（P<0.05）；三组患者的检查成功率（94%；98%；97%）、息肉检出率（19.15%；24.49%；23.71%）、腹部按压及体位变化等均无统计学差异（P>0.05）；其中，腹痛评分注气组明显高于注水组（P<0.05），室温水组与加热水组间无差异（P>0.05）；肠镜检查满意度注水组明显高于注气组（P<0.05），室温水组与加热水组间无差异（P>0.05）；达回盲部时间与退镜时间注水组明显长于注气组（P<0.05），室温水组与加热水组间无差异（P>0.05）。 结论在非麻醉的肠镜检查中，注水法能够减少患者的腹痛，提高患者满意度，但与注气法相比会延长操作时间。水温的升高对患者的腹痛评分、到达回盲部时间、退镜时间、肠镜检查满意度、检查成功率、息肉的检出率、体位变化及腹部按压等无影响。因此室温水也可用于注水肠镜检查中。     

Virtual gastrointestinal colonoscopy in combination with large bowel endoscopy: Clinical application

Although colorectal cancer (CRC) has no longer been the leading cancer killer worldwide for years with the exponential development in computed tomography (CT) or magnetic resonance imaging, and positron emission tomography/CT as well as virtual colonoscopy for early detection, the CRC related mortality is still high. The objective of CRC screening is to reduce the burden of CRC and thereby the morbidity and mortality rates of the disease. It is believed that this goal can be achieved by regularly screening the average-risk population, enabling the detection of cancer at early, curable stages, and polyps before they become cancerous. Large-scale screening with multimodality imaging approaches plays an important role in reaching that goal to detect polyps, Crohn’s disease, ulcerative colitis and CRC in early stage. This article reviews kinds of presentative imaging procedures for various screening options and updates detecting, staging and re-staging of CRC patients for determining the optimal therapeutic method and forecasting the risk of CRC recurrence and the overall prognosis. The combination use of virtual colonoscopy and conventional endoscopy, advantages and limitations of these modalities are also discussed.     

Management of Small Polyps Detected by Screening CT Colonography: Patient and Physician Preferences

Background

Management of small polyps found on computed tomography (CT) colonography is controversial and critical to both cancer outcomes and cost. Patient and physician behavior are influenced by personal beliefs and prior experience. Thus, we aimed to understand patient and physician preferences after finding polyps on CT colonography.

Methods

Patients were given a validated handout and survey asking for their preference for evaluation of a “pea-sized” polyp found on CT colonography. By using an Internet survey, physicians were asked how they would manage a 5-mm, 8-mm, or 12-mm polyp, or three 5-mm polyps found by CT colonography in a hypothetical 52-year-old patient of average colorectal cancer risk. Survey reliability was assessed using Cronbach's coefficient alpha.

Results

Of the 305 patient respondents, 95% wanted to know if the polyp found on CT colonography was precancerous, 86% stated they would request endoscopic evaluation, and 85% wanted polypectomy. Of the 277 primary care physicians, 71% would refer a 5-mm sigmoid polyp for endoscopy, 86% would refer an 8-mm polyp, 97% would refer a 12-mm polyp, and 91% would refer three 5-mm polyps. Of the 461 gastroenterologists, 83% would refer a 5-mm sigmoid polyp for endoscopy, 96% would refer an 8-mm polyp, 97% would refer a 12-mm polyp, and 93% would refer three 5-mm polyps. Overall, 75% of physicians indicated the fear of missing a precancerous lesion would prompt referral for colonoscopy.

Conclusion

Both patients and physicians overwhelmingly preferred to follow up small polyps identified by CT colonography with endoscopy, suggesting that population-based CT colonography screening programs in which polyps are not removed might require significant patient and physician education before implementation.     

窄带成像结肠镜对结肠息肉样病变的诊断价值

探讨窄带成像（NBI）结肠镜对结肠息肉样病变的病理组织类型的预测能力.方法 125例患者接受结肠镜检查诊断结肠息肉样病变173个,根据腺管开口形态及NBI下血管分型判定该病变为肿瘤性病变（结肠腺瘤、结肠癌）或非肿瘤性病变,并与病理结果对照,判定各种方法的敏感性、特异性及准确率.结果 NBI下血管形态鉴别肿瘤性或非肿瘤性病变的敏感性、特异性及准确率（94.83%、91.23%、93.64%）以及隐窝形态结合血管形态鉴别肿瘤性或非肿瘤性病变的敏感性、特异性及准确率（95.69%、96.49%、95.59%）显著高于常规内镜（80.17%、84.21%、81.50%）（P〈0.05）.血管形态鉴别腺瘤与结肠癌的敏感性、特异性、准确率为86.90%、100.00%、87.93%.结论 NBI模式下结肠镜检查对息肉样病变的肿瘤性、非肿瘤性,结肠腺瘤、结肠癌的鉴别优于常规内镜检查,接近病理学检查.