各肠道节段退镜时间与结肠镜质量的关系
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1.江苏省人民医院;2.无锡市人民医院消化内科

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无锡市卫健委中青年拔尖人才资助计划(BJ2020011)


Relationship between the endoscopic withdrawal time at different colonic segments and the quality of colonoscopy
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Affiliation:

jiangsu province hospital

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Support Program for the Young and Middle-aged Top Talents of Wuxi Health Committee (BJ2020011)

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    摘要:

    目的 探讨各个肠道节段合理的退镜时间。方法 前瞻性观察研究自2019年11月—2020年11月于本消化内镜中心行结肠镜检查的465例患者,再回顾性分析自2017年7月—2017年9月本中心的结肠镜检查记录,以作验证集。结果 采用受试者工作特征(receiver operating characteristic,ROC)曲线确定升结肠段、横结肠段、降结肠段以及乙状结肠直肠段的退镜时间阈值分别为77 s、61 s、56 s及109 s。升结肠段中,当退镜时间≥77 s时,升结肠段的腺瘤检出率(adenoma detection rate,ADR)显著增加(17.3%比2.8%,P<0.001)。同样,横结肠段退镜时间≥61 s时的ADR(6.9%比2.8%,P=0.036),降结肠段段退镜时间≥56 s的ADR(6.3%比1.7%,P=0.019),乙状结肠直肠段退镜时间≥109 s时的ADR(31.0%比7.9%,P<0.001),均显著增加。多因素Logistic回归分析显示,升结肠段退镜时间≥77 s(OR=6.427,P<0.001),降结肠段退镜时间≥56 s(OR=3.564,P=0.045),乙状结肠直肠段退镜时间≥109 s(OR=5.073,P<0.001)是各肠段ADR增加的独立影响因素。验证集中,当升结肠段、横结肠段、降结肠段及乙状结肠直肠段退镜时间分别≥77 s、61 s、56 s、109 s时,全肠道的ADR(48.3%比17.6%,OR=2.952,P<0.001)及息肉检出率(polyp detection rate,PDR)(63.2%比23.0%,OR=4.191,P<0.001)均显著增加。与退镜时间>6 min的结肠镜检查相比,二者ADR(P=0.563)及PDR(P=0.770)差异无统计学意义。结论 当升结肠段、横结肠段、降结肠段及乙状结肠直肠段的退镜时间分别≥77 s、61 s、56 s、109 s时,各肠段及全肠道的ADR及PDR均显著升高。

    Abstract:

    Objective To explore the reasonable withdrawal time at different colonic segments. Methods It was a prospective observational study involving 465 patients who underwent colonoscopy from November 2019 to November 2020 at our endoscopy center. Colonoscopy records in our center from July 2017 to September 2017 were retrospectively analyzed as a validation set. Results The cut-off values of withdrawal time at ascending colon, transverse colon, descending colon, and sigmoid colon and rectum determined by receiver operating characteristic (ROC) curve were 77 s, 61 s, 56 s, and 109 s, respectively. At the ascending colon, the adenoma detection rate (ADR) was significantly higher (17.3% VS 2.8%, P<0.001) when the colonoscopy withdrawal time was ≥77 s. When the withdrawal time was ≥61 s at the transverse colon (6.9% VS 2.8%,P=0.036), that over 59 s at the descending colon (6.3% VS 1.7%,P=0.019), and that ≥109 s at the sigmoid colon and rectum (31.0% VS 7.9%,P<0.001), the ADR was significantly higher. Multivariate analysis showed that withdrawal time of ≥77 s at the ascending colon (OR=6.427, P<0.001), those ≥56 s at the descending colon (OR=3.564, P=0.045) and ≥109 s at the sigmoid colon and rectum (OR=5.073, P<0.001) were independent risk factors for the increase of ADR. In the validation set, when the withdrawal times at the ascending colon, the transverse colon, the descending colon, and the sigmoid colon and rectum were ≥77 s, 61 s, 56 s, and 109 s, respectively, the total ADR (48.3% VS 17.6%, OR=2.952, P<0.001) and polyp detection rate (PDR) (63.2% VS 23.0%, OR=4.191, P<0.001) significantly increased. There were no significant differences in ADR (P=0.563) or PDR (P=0.770) compared with those where withdrawal time was over 6 min. Conclusion The ADR and PDR significantly increase when the withdrawal times are ≥77 s at the ascending colon, ≥61 s at the transverse colon, ≥56 s at the descending colon, and ≥109 s at the sigmoid colon and rectum.

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吴瑞,杨成,占强.各肠道节段退镜时间与结肠镜质量的关系[J].中华消化内镜杂志,2021,38(12):1003-1007.

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  • 收稿日期:2020-12-01
  • 最后修改日期:2021-12-01
  • 录用日期:2021-02-22
  • 在线发布日期: 2021-12-27
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