【作者】 张燕；

【导师】 贾欣永；

【作者基本信息】 泰山医学院 ， 内科学 消化内科（专业学位）， 2016， 硕士

【摘要】 目的探讨结肠镜前置先端帽(Cap-assisted colonoscopy CAC)对结肠腺瘤检出率、到达回盲部成功率及到达回盲部所用时间的影响。方法收集2014年9月~2015年11月在山东省千佛山医院内镜诊疗科行结肠镜检查的患者,入组共1285例,将患者随机分为2组,即前置先端帽组(Cap-assisted Colonoscopy CAC)和普通组(Standard Colonoscopy SC),对两组到达回盲部成功率进行统计学分析。试验完毕后最终对1150人(CAC组572人,SC组578人)到达回盲部所用时间及腺瘤检出率进行比较;并以腺瘤外观形态分层,统计分析两组间结肠腺瘤平均检出数。结果1、到达回盲部成功率(1285例):CAC组(636)99.7%,SC组(636)98.2%,差异有统计学意义(P<0.05)。2、到达回盲部所用时间(1150例):CAC组(5.27±1.98)min较SC组(5.81±2.14)min缩短(P<0.05)。并以操作者的操作水平分层,示先端帽可以明显缩短独立操作<500例、500~3000例的操作者到达回盲部所用时间。3、腺瘤检出率ADR(adenoma detection rate):ADR:CAC组:总ADR为42%,右半结肠ADR31%,左半结肠ADR25%;SC组:总ADR35%,右半结肠ADR19%,左半结肠ADR26%。两组总ADR及右半结肠ADR相比较,两组差异均有统计学意义(P<0.05);左半结肠ADR相比较,两组差异无统计学意义(P>0.05)。以操作者的操作水平分层,分析先端帽对腺瘤检出率的影响。4、以结肠腺瘤大小及外观形态分层,分析先端帽对腺瘤平均检出数的影响:直径<6mm的腺瘤平均检出数,CAC组及SC组分别为(0.64±1.02)枚、(0.44±0.89)枚,差异有显著的统计学意义(P<0.05);直径≥6mm的腺瘤平均检出数,两组间无明显差别。山田I型及山田II型腺瘤平均检出数,两组之间有明显差异(P<0.05);山田III型及山田IV型,两组间无明显差别(P>0.05)。5、两组均无死亡、出血及穿孔等并发症。结论1、先端帽可以提高结肠腺瘤检出率,特别是对右半结肠腺瘤检出率影响显著;可以明显提高独立操作结肠镜500~3000例的操作者的腺瘤检出率,对于操作达3000例以上的操作者,先端帽可以提高其右半结肠腺瘤检出率。2、先端帽可以明显提高直径<6mm腺瘤平均检出数;同时可以明显提高山田I型及山田II型腺瘤平均检出数。3、先端帽可以提高到达回盲部成功率。4、先端帽可以缩短独立操作结肠镜不足3000例的操作者到回盲部所用的时间,特别是对于独立操作不足500例的操作者影响显著。更多还原

【Abstract】 Abjective:To investigate the clinical usefulness of the cap-assisted colonoscopy for adenoma detection rate(ADR),caecal intubation rate,caecal intubation time.Methods:Patients for colonoscopy between September 2014 and November 2015 in Shandong province Qianfo Hill hospital were enrolled to this randomized controlled trial.There were1285 cases admitting for screening,Which were 1:1 randomised to either CAC(638)or SC(647).The evaluated outcomes was cacal intubation rate according to the 1285 cases.However a total of 1150 cases(CAC(572 cases)or SC(578 cases))conforming to the requirement.The evaluated outcomes were adenoma detection rate,intubation time.And the evaluated outcomes were comparable according to the endoscopy level,the diameter and the appearance of the adenoma.Results:1.Caceal intubation rateA tolal of 1285 participants were randomly allocated to CAC(N=638)or SC(N=647).Caceal intubation rate was comparable in the two groups(99.7% vs 98.2%;P<0.05).2.Caceal intubation timeA tolal of 1150 participants were randomly allocated to CAC(N=572)or SC(N=578).Caceal intubation time was significantly lower in the CAC group:5.27±1.98 min with CAC vs 5.81±2.14 min with SC(P<0.05)(values mean±SD).Meanwhile,the intubarion time was comparable according to the level of the endoscopy.CAC dose reduce caecal intubation time for the endoscopy,who dose the colonoscopy less than 3000 cases.3.Adenoma detection rateThe proportion of subjects with at least one adenoma(ADR)was significantly higher in the CAC group:42% with CAC group vs 35% with SC(P<0.05).The ADR in the rightcolon was higher in the CAC group:31% with CAC group vs 19% with SC(P<0.05).But the ADR of the left colon was similar in the two groups(25% vs 26%).Meanwhile,ADR was comparable according to the level of the endoscopy.4.The detection of adenoma according to the diameter and the appearance.The polyp detection with small size(<6mm)was higher in the CAC group:(0.64±1.02)per subject with CAC vs(0.46±0.89)per subject with SC(P<0.05)(values mean±SD),while there was no impact in the big size(≥ 6mm).The dection of Yamada-I and Yamada-II adenama were higher in the CAC group(P<0.05).5.ComplicationsSubjects were contacted 2 weeks after the colonoscopy.There were non-colonoscopyrelated complications occurred in the two groups.Conclusion1.Cap-assisted colonoscopy significantly increased adenoma detection rate,especially in the right colon.Though the effect was influenced by the level of the endoscopy.Capassisted colonoscopy may increased adenoma detection rate for the endoscopy,who dose the colonoscopies between 500 and 3000 cases.But Cap-assisted colonoscopy just increased adenoma detection rate for the endoscopy,who dose the colonoscopies more than3000 cases2.Cap-assisted colonoscopy could increase the detection of small size adenoma(<6mm).And it could increase the detection of Yamada-I and Yamada-II adenoma.3.Cap-assisted colonoscopy did increase the caceal intubation rate.4.Cap-assisted colonoscopy shorted the caceal intubation time especially for the trainees.更多还原