结直肠腺瘤切除后患者的内镜随访研究

Endoscopic follow‑up study of patients after colorectal adenoma resection

摘要:

目的 调查结直肠腺瘤（colorectal adenoma，CRA）切除患者随访结肠镜检查情况，为提高结肠镜检查质量和减少漏诊提供依据。方法 连续纳入2020年10月至2021年10月间189例CRA切除患者1年后随访结肠镜检查。采用波士顿肠道准备评分量表（Boston bowel preparation scale，BBPS）评价患者肠道准备的效果。记录CRA患者切除时及其1年后随访的两次结肠镜检查中腺瘤部位、个数、大体形态，与主要临床病理特征及随访结肠镜漏诊CRA进行分析。结果 189例CRA切除患者右半结肠、横结肠、左半结肠、总的BBPS评分，1年后随访结肠镜检查结果［（1.93±0.42）、（2.53±0.52）、（2.77±0.45）、（7.22±1.03）分］和CRA切除时结肠镜检查结果［（2.08±0.35）、（2.70±0.46）、（2.81±0.40）、（7.57±0.84）分］比较，除左半结肠肠段外（χ2=0.98，P>0.05），其他肠段差异均有统计学意义（P<0.05）。CRA切除时右半结肠、横结肠、左半结肠肠段和全肠段检出CRA分别为62、66、210和338枚；1年后随访结肠镜检查对应肠段和全肠段漏诊CRA分别为21、38、49和108枚。CRA漏诊与患者年龄（≥60岁漏诊者占54.2%）、性别（男性漏诊者占81.9%）、腺瘤所在肠段（左半结肠漏诊者占36.2%）和大体形态（平坦型占72.3%）相关（P<0.05），与植物性膳食、胆囊或阑尾切除史、烟酒嗜好、腺瘤个数和病理类型无关（P>0.05）。结论 CRA切除患者漏诊腺瘤以平坦型为主，与患者年龄、性别、腺瘤所在肠段和大体形态相关。

Abstract:

Objective To investigate the follow-up colonoscopy of patients after colorectal adenoma (CRA) resection, so as to improve colonoscopy quality and reduce missed CRA diagnosis. Methods A total of 189 patients after CRA resection who underwent follow-up colonoscopy from October 2020 to October 2021 were consecutively recruited. The effect of bowel preparation was evaluated by the Boston bowel preparation scale (BBPS). The location, the number, and gross morphology of adenomas during CRA resection and two colonoscopies during 1 year follow-up after the resection were recorded, and their correlation with major clinicopathologic features were analyzed, and the missed CRA in follow-up colonoscopy were also analyzed. Results The BBPS scores of the right colon, transverse colon, left colon and total colon in 189 patients who underwent CRA resection were 1.93±0.42, 2.53±0.52, 2.77±0.45, and 7.22±1.03 points at the 1-year follow-up colonoscopy and 2.08±0.35, 2.70±0.46, 2.81±0.40, and 7.57±0.84 points at the time of CRA resection. Except for the left colon segment (χ2=0.98, P>0.05), the differences in other colon segments were significantly different (P<0.05). At the time of CRA resection, 62, 66, 210 and 338 CRAs were detected in the right colon, transverse colon, left colon and total colon segments, respectively. At the 1-year follow-up colonoscopy, 21, 38, 49 and 108 CRAs were missed in the corresponding colon segments and total colon, respectively. CRA missed diagnosis was related to patient age (≥60 years accounting for 54.2%), gender (males accounting for 81.9%), adenoma location (predominantly in the left colon comprising 36.2%) and gross morphology (flat types representing 72.3%) (P<0.05), but not related to being vegetarian, history of cholecystectomy or appendectomy, smoking or alcohol consumption, number of adenomas or pathological type (P>0.05). Conclusion The missed diagnosis of CRA in patients after CRA resection primarily involves the flat type adenomas, which is associated with the age, gender, adenoma location within the colon and the gross morphology.