结肠镜检查大肠息肉漏诊相关因素分析

目的 探讨结肠镜检查中大肠息肉的漏诊率及其相关因素.方法 回顾性分析2009年7月至2013年6月间186例初次结肠镜检查发现并切除息肉后半年内进行结肠镜复查患者的资料,统计分析以下相关因素：病变相关因素：包括病变大小、部位、形态、数目及病理;非病变因素：包括肠道清洁度、退镜时间、操作者经验、是否麻醉状态等.结果 186例患者中57例发生息肉漏诊,患者息肉漏诊率30.64％（57/186）,2次结肠镜检查共检出息肉343枚,漏诊76枚,息肉总漏诊率22.16％ （76/343）;平坦型小息肉容易漏诊（P＜0.01）,乙状结肠、盲升结肠和肝曲、脾曲部位的息肉容易漏诊（P＜0.05）,肠道清洁度差、退镜时间短、未静脉麻醉及初级内镜医师漏诊率明显增加（P＜0.01）.结论 结肠镜检查中存在部分息肉漏诊,息肉漏诊与病变相关因素（包括病变大小、部位、形态、数目及病理）和非病变因素（包括肠道清洁度、退镜时间、操作者经验、是否麻醉状态）等密切相关.

The rate and correlation factors of missing diagnosis of colorectal polyps with colonoscopy

Objective To investigate the missing rate of polypus with colonoscopy and correlation factors for missed diagnosis.Methods Data with colorectal polyps collected a second colonoscopy within 180 days after polyps were detected and removed on the initial colonoscopy in 186 patients between July 2009 and June 2013.The following factors were statistically analyzed,including lesionrelated factors （the lesion size,location,shape,number,and pathology）,and non-lesion-related factors （intestinal cleanliness,colonoscopy post-set time,colonoscopy operator experience,and whether colonoscopy with sedation）.Results Polypus missed diagnosis was found in 57 patients out of 186 recruited subjects （30.64%）.A total of 76 polypus were missed out of 343 （22.16%） polypus detected by repeated colonoscopy.Flat small polyps were easily missed diagnosis （P 〈 0.01）.Polyps located at sigmoid,cecum and ascending colon,hepatic flexure,and splenic flexure were easily missed diagnosis （P 〈0.05）.The rate of missed diagnosis was significantly increased in the condition of the low intestinal cleanliness,short colonoscopy post-set time,non-intravenous anesthesia,and beginner colonoscopy doctors （P 〈 0.01）.Conclusions A markedly missing rate of polyp existed on colonoscopy,and was closely related to the lesion-related factors （the lesion size,location,shape,number,and pathology） and the non-lesion-related factors （the intestinal cleanliness,colonoscopy post-set time,colonoscopy operator experience,and whether colonoscopy with sedation）.