光学增强内镜（OE）与高清白光内镜对结直肠腺瘤检出率的对比研究

发布时间：2018-04-05 09:22

本文选题：光学增强内镜　切入点：腺瘤　出处：《山东大学》2017年硕士论文

【摘要】：背景与目的:结直肠癌是世界上最常见的恶性肿瘤之一,它严重威胁着人类的健康,其发病率呈现出逐渐增加的趋势。结肠镜检查被广泛应用于结肠肿瘤的筛查,通过内镜下早期发现并且切除结直肠腺瘤被认为是预防结直肠癌的最有效的方法。但有研究发现,在普通结肠镜检查时,会漏诊15-32%的腺瘤。漏诊的原因可能有技术方面的原因,例如退镜时间过快不能做到细致的观察、腺瘤被肠道皱襞遮挡等,也有可能与设备有关,例如平坦型较小的病变由于外形不显著以及与周围肠粘膜对比性差而被忽视。近年来,新型内镜技术不断出现,并且用于提高腺瘤检出率的研究中,例如窄带成像技术、最佳谱带成像系统等,但结论不一,以上技术未能广泛应用到结肠镜的筛查中,很重要的原因是以上电子染色内镜技术在肠腔中呈现出较暗的视野,这限制了它们优势的发挥。光学增强内镜(Optical Enhancement,OE)是一种新型光学染色内镜,能增加正常肠道黏膜与异常病变的对比度,并且可以在肠腔中提供较亮的视野。本研究即通过观察不同患者分别使用光学增强内镜或者高清白光内镜进行肠道检查时的检查效果,探究与高清白光内镜相比,光学增强内镜能否提高腺瘤的检出率。方法:在2016年8月至2016年12月期间,我们纳入符合纳入标准的前来行结肠镜检查的患者,研究中共有302名患者,随机分为2组,其中光学增强内镜组152人,高清白光内镜组150人,行结肠镜检查时,两组患者均以高清白光内镜模式进镜,到达回盲部后退镜观察,退镜时光学增强内镜组打开OE2模式退镜观察,直至检查结束,高清白光内镜组通过高清白光内镜模式退镜观察。记录患者的基本资料、肠道准备情况、退镜时间、发现的息肉,以及息肉的特点等,对于发现的息肉取病理,比较两组间发现息肉及腺瘤的个数,比较两组间息肉及腺瘤的检出率,比较两组发现腺瘤的特点的不同。结果:光学增强内镜组与高清白光内镜组间患者的男女比例、年龄、检查指征、麻醉人数比、肠道准备情况及退镜时间等均无明显差异,在光学增强内镜组中,至少有1枚息肉的患者为81人,至少有1枚腺瘤的患者为59人,在高清白光内镜组中,至少有1枚息肉的患者为68人,至少有1枚腺瘤的患者为44人,光学增强内镜组中的息肉及腺瘤检出率均高于高清白光内镜组(息肉:53.3%vs 45.3%,p=0.167;腺瘤:38.8%vs 29.3%,p=0.082),但是均未到达统计学差异。光学增强内镜组发现无蒂型腺瘤68枚,亚蒂型腺瘤36枚,带蒂型腺瘤13枚,高清白光内镜组发现无蒂型腺瘤39枚,亚蒂型腺瘤35枚,带蒂型腺瘤15枚,光学增强内镜组发现无蒂型腺瘤高于高清白光内镜组(p=0.042),两组间亚蒂型腺瘤及带蒂型腺瘤无明显差异。光学增强内镜组发现直径6mm的腺瘤76枚,直径6-10mm的腺瘤25枚,直径10mm的腺瘤16枚,高清白光内镜组发现直径6mm的腺瘤45枚,直径6-10mm的腺瘤28枚,直径10mm的腺瘤16枚,光学增强内镜组发现直径6mm的腺瘤高于高清白光内镜组(p=0.038),两组间发现直径6-10mm的腺瘤及10mm的腺瘤无明显差异。连续比较两种内镜模式在第一个、第二个、第三个、第四个75名受试者中腺瘤的检出率,光学增强内镜具有较为较为恒定的表现(39.5%,34.2%,42.1%,39.5%),而高清白光内镜组表现出逐渐提高的趋势(23.7%,29.7%,31.6%,32.4%)。结论:1.光学增强内镜比高清白光内镜有更高的息肉和腺瘤检出率,但是未能达到统计学差异。2.在无蒂型腺瘤和微小腺瘤检出方面,光学增强内镜优于高清白光内镜。3.光学增强内镜学习方便,易于掌握,在检出腺瘤方面学习曲线短于高清白光内镜。
[Abstract]:Background and purpose: colorectal cancer is one of the most common malignant tumor in the world, it is a serious threat to human health, the incidence rate showed a gradually increasing trend. Screening colonoscopy is widely used in colon cancer, early detection and resection by endoscopic colorectal adenoma is considered to be the most effective way of preventing colorectal cancer. But researchers have found that in ordinary colonoscopy, missed 15-32% adenoma. The causes of misdiagnosis may have technical problems, such as the back mirror too soon can not do meticulous observation, the adenoma is intestinal folds occlusion, there may be associated with the device, such as a flat type because the appearance of smaller lesions and no significant difference between peripheral intestinal mucosa and neglected. In recent years, new endoscopic technologies, and to improve the study of adenoma detection rate, such as narrow band imaging technology The best spectral band, imaging system, but no conclusion, more than technique is not widely applied to screening colonoscopy, a very important reason is the electronic staining endoscopy technology presents a dark vision in the intestinal cavity, which limits their advantages. Optical enhancement (Optical Enhancement, OE) endoscopy is a new type of optical chromoendoscopy, can increase the normal intestinal mucosa and abnormal contrast, and can provide a brighter view in the intestinal cavity. This study through the observation using optical enhancement of intestinal endoscopy or HD in the white light mirror when the examination of the effect of different patients, compared with HD on white light endoscopy, optical can improve the detection rate of enhanced endoscopic adenoma. Methods: in the period from August 2016 to December 2016, we enrolled patients who met the inclusion criteria to colonoscopy, a total of 302 patients, Were randomly divided into 2 groups, including optical enhancement Endoscopy Group 152, group 150 HD endoscopy, colonoscopy, two groups of patients with HD endoscopy mode into the mirror, at ileocecus back mirror observation, back mirror optical enhancement Endoscopy Group to open the OE2 model back mirror observation, until the end of the examination HD, white light Endoscopy Group by HD microscope. White light endoscopy mode back records the basic data of patients with bowel preparation, colonoscopy time, found polyps, as well as polyp characteristics, the polyp biopsy, were compared between the two groups found that the number of polyp and adenoma, adenomatous polyp detection rate and comparison between the two groups, compared two groups of adenoma found different features. Results: the optical enhancement group and endoscopic HD white light endoscopy groups the proportion of men and women, age, check the indication of anesthesia than the number of bowel preparation, and colonoscopy time were not significantly The difference in optical enhancement, Endoscopy Group, at least 1 polyps in patients with 81, at least 1 cases of adenoma were 59 patients in the HD, white light endoscopy group, at least 1 polyps in patients with 68, at least 1 cases of adenoma were 44 patients, the detection rate of optical enhancement polyp and adenoma endoscope group were higher than in HD group (white light endoscopy polyp: 53.3%vs 45.3%, p=0.167; adenoma: 38.8%vs 29.3%, p=0.082), but did not reach significant difference. Optical enhancement Endoscopy Group found no pedicle adenoma in 68 cases, Artie adenoma 36, pedicled adenoma 13, white HD endoscopic group found sessile adenoma in 39 cases, Artie adenoma in 35 cases, pedicle adenoma in 15 cases, enhanced optical endoscopy group found no pedicle adenoma than the HD Endoscopy Group (p=0.042), the two groups had no significant difference between adenoma and pedicle Artie adenoma. Endoscopic optical enhancement group found that the diameter of 6mm 7 adenomas 6, the diameter of 6-10mm adenoma 25, the diameter of 10mm adenoma in 16 cases, HD group found that the diameter of 6mm white light endoscopic adenoma 45, the diameter of 6-10mm adenoma 28, the diameter of 10mm adenoma in 16 cases, endoscopic optical enhancement group found that the diameter of 6mm is higher than that of white light endoscopy group adenoma HD (p=0.038) between the two groups. We found no significant difference in the diameter of 6-10mm 10mm in adenoma and adenoma. For comparison of two kinds of endoscopic mode in the first, second, third, detection rate of fourth adenomas in 75 subjects, with a relatively constant enhancement of optical endoscopic performance (39.5%, 34.2%, 42.1%, 39.5%), and white HD endoscopic group showed a trend of gradual increase (23.7%, 29.7%, 31.6%, 32.4%). Conclusion: 1. optical enhancement endoscopy has a higher detection rate of polyps and adenomas than HD white light endoscopy, but failed to reach statistical differences of.2. in sessile adenomas and micro adenoma detection, optical Enhanced endoscopy is superior to high definition white light endoscopy.3. optical endoscopy, easy to learn, easy to master, and shorter learning curve in detection of adenomas than high definition white endoscopy.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.34

【相似文献】