健康体检中内镜检查的应用价值

目的评价健康体检内镜检查临床价值和意义。方法回顾分析解放军总医院海南分院2012年08月01~2016年08月01所有在消化内镜中心接受健康体检内镜检查者的内镜和相关资料,包括年龄、性别、主诉、13C呼气试验结果、是否麻醉、术中或术后并发症、内镜诊断和病理结果等,评价健康体检内镜检查的有效性和安全性。结果接受健康体检内镜检查的患者共1 173例,男865例,女308例,平均年龄(52.5±9.9)岁,1 029例(88%)为无症状健康体检者;合计进行胃肠镜共2 275例次,其中麻醉下无痛胃肠镜2 130例次(93.6%);发现癌前病变28例(包括各种程度异型增生),明确消化道癌10例(0.85%),其中胃癌2例,结肠癌8例;10例癌症中早癌4例(40%),均经内镜或手术切除术后病理证实。经Logistic回归分析,消化道癌前病变及消化道癌与体检对象年龄、性别、幽门螺杆菌感染、主诉等无统计学相关(P0.05)。内镜诊治过程中黏膜出血48例(2.1%),均经内镜治疗成功,无其他严重及麻醉相关并发症。结论健康体检内镜检查可以有效发现消化道恶性病变,尤其是消化道早癌。经内镜确诊的恶性病变与患者年龄、性别、幽门螺杆菌感染、消化道症状等均无相关性。健康体检内镜检查具备较高安全性,术中出现相关并发症主要为出血,均可经内镜处理,严格的麻醉和监护可降低或避免相关风险。

Values of screening gastrointestinal endoscopy in physical examination

Objective To evaluate values of routine gastrointestinal endoscopic screening in physical examination. Methods A retrospective analysis was conducted in cadres who received gastrointestinal endoscopy screening in Hainan Branch of PLA General Hospital Between August 2012 and August 2016. Clinical data were collected,including age,gender,chief complaints,13C urea-breath test,whether anesthesia,complications of intra/post-operative and the final diagnosis. Results Total of 2275 endoscopy procedures were performed in 1173 subjects (865 male and 308 female),with the mean age of 52.5 ± 9.9,and 2130(93.6%) were under anesthesia. Precancerous lesions were detected in 28 cases. Gastrointestinal cancer was conformed in 10 cases (0.85%),of which 2 were gastric cancer and 8 colon cancer. Early cancer was detected in four cases ,with a detection rate of 40%. Multiple logistic regression model showed that the occurrence of precancerous and/or cancerous lesions was no related to age ,gender,HP infection and chief complaints (P > 0.05). Intra-operative mucosal bleeding occurred in 48 cases and cured by immediately via endoscopic hemostasis. No severe complication was recorded as well as anesthesia-associated adverse reactions. Conclusion Gastrointestinal endoscopy screening in physical examination is an effective method for gastrointestinal cancer detection ,especially the early/pre-cancerous lesions. Malignant lesion detected by endoscopy is independent form age ,gender,HP infection and chief complaints. Gastrointestinal endoscopy screening in physical examination is safe and severe complications can be avoided by intensive anesthetic monitoring and endoscopic hemostasis.