透明帽辅助水交换结肠镜联合窄带成像内镜检查的临床应用价值

Clinical application value of transparent cap assisted water exchange colonoscopy combined with NBI examination

摘要:

目的 探讨透明帽辅助水交换结肠镜联合窄带成像内镜（NBI）检查在临床中的应用价值。方法 纳入2019年6月－2020年3月该院内镜中心拟行结肠镜检查的初诊患者240例，随机分为空气组、水交换组及水交换联合NBI组，每组各80例。空气组为注气结肠镜检查；水交换组为注水结肠镜检查，退镜时采用白光观察；水交换联合NBI组为注水结肠镜检查，退镜时采用NBI观察。结肠镜检查均在非麻醉状态下进行，3组患者结肠镜检查时肠镜头端均携带同一型号的透明帽，由同一位技术熟练的高年资医师完成结肠镜操作。分析比较3组患者的肠镜进镜时间、达盲率、退镜时间、肠道清洁度、腹痛情况、腺瘤检出率、麻醉需求率及愿意再次行肠镜率的差异。结果 水交换组肠镜进镜时间为（5.02±0.70）min、水交换联合NBI组为（5.05±0.85）min，均较空气组肠镜进镜时间（4.02±0.80）min长，3组患者比较，差异有统计学意义（F = 43.72，P < 0.01）；3组患者达盲率比较，差异无统计学意义（P > 0.05）；空气组退镜时间为（6.53±0.90）min，短于水交换组的（8.72±0.72）min和水交换联合NBI组的（8.84±0.77）min，3组患者比较，差异有统计学意义（F = 208.46，P < 0.01）；3组患者肠道清洁度（Boston评分）比较，差异无统计学意义（F = 0.53，P > 0.05）；空气组腹痛评分为（2.88±1.91）分，高于水交换组的（1.93±1.48）分和水交换联合NBI组的（1.94±1.49）分，3组患者比较，差异有统计学意义（F = 8.67，P < 0.01）；水交换联合NBI组的腺瘤检出率最高（38.8%，31/80），与其他两组比较，差异有统计学意义（χ² = 5.84，P < 0.05；χ² = 4.91，P < 0.05）；空气组麻醉需求率（21.3%，17/80）高于水交换组（8.8%，7/80）和水交换联合NBI组（6.3%，5/80），两两比较，差异有统计学意义（χ² = 4.90，P < 0.05；χ² = 7.61，P < 0.05）；空气组愿意再次行肠镜率（71.3%，57/80）低于水交换组（86.3%，69/80）和水交换联合NBI组（88.8%，71/80），两两比较，差异有统计学意义（χ² = 5.39，P < 0.05；χ² = 7.67，P < 0.05）。结论 透明帽辅助水交换结肠镜联合NBI检查可提高腺瘤的检出率，减轻患者腹痛感，降低麻醉需求率，提高患者愿意再次行肠镜率。

Abstract:

Objective To explore the clinical application value of transparent cap assisted water exchange colonoscopy combined with NBI examination.Methods 240 patients underwent colonoscopy from June 2019 to March 2020 were included, they were randomly divided into the air group, the water exchange group and the water exchange combined NBI group, 80 patients in each. Air injection colonoscopy was used in the air group; Water exchange group was water injection colonoscopy, white light observation is used when backtracking; Water exchange combined NBI group was also water injection colonoscopy, NBI observation is used when backtracking. All patients underwent colonoscopy without anesthesia, patients in the three groups were all fitted with the same type of transparent cap at the end of the intestinal lens during colonoscopy, all examinations were performed by a senior physician skilled in colonoscopy. Postoperative analysis was performed to compare the differences among the three groups in colonoscopy entry time, cecal arrival rate, endoscopy exit time, intestinal cleanliness, abdominal pain, adenoma detection rate, anesthesia demand rate and willingness to undergo colonoscopy again.Results Colonoscopy entry time was (5.02 ± 0.70) min in the water exchange group and (5.05 ± 0.85) min in the water exchange combined NBI group, both of which were longer than that in the air group (4.02 ± 0.80) min, the difference was statistically significant (F = 43.72, P < 0.01); There was no significant difference in the cecal arrival rate among the three groups (P > 0.05). The endoscopy exit time of the air group was (6.53 ± 0.90) min, which was lower than (8.72 ± 0.72) min of the water exchange group and (8.84 ± 0.77) min of the water exchange combined with NBI group, the difference was statistically significant (F = 208.46, P < 0.01); There was no significant difference in intestinal cleanliness (Boston score) among the groups (F = 0.53, P > 0.05). Abdominal pain score was (2.88 ± 1.91) in the air group, which was higher than (1.93 ± 1.48) of the water exchange group and (1.94 ± 1.49) of the water exchange combined NBI group, the difference was statistically significant (F = 8.67, P < 0.01); Adenoma detection rate was highest in the water exchange combined NBI group (38.8%, 31/80), compared with the other two groups, the difference was statistically significant (χ² = 5.84, P < 0.05; χ² = 4.91, P < 0.05); The anesthesia demand rate in the air group (21.3%, 17/80) was higher than that in the water exchange group (8.8%, 7/80) and the water exchange combined NBI group (6.3%, 5/80), the difference was statistically significant (χ² = 4.90, P < 0.05; χ² = 7.61, P < 0.05); The air group (71.3%, 57/80) underwent colonoscopy again was lower than the water exchange group (86.3%, 69/80) and the water exchange combined NBI group (88.8%, 71/80), with statistically significant difference (χ² = 5.39, P < 0.05; χ2 = 7.67, P < 0.05).Conclusion Transparent cap assisted water exchange colonoscopy combined NBI examination can improve the detection rate of adenoma, reduce the rate of abdominal pain and anesthesia demand, and improve the willingness of patients to undergo colonoscopy again.