结肠镜窄带成像技术联合反转技术对提高右半结肠息肉样病变检出率及诊断效能的有效性研究

Study on the effectiveness of colonoscopy narrow band imaging combined with reversal technique in improving the detection rate and diagnostic efficiency of polypoid lesions in the right colon

摘要:

目的 探讨结肠镜窄带成像技术（NBI）联合反转技术对提高右半结肠息肉样病变检出率及诊断效能的影响。方法 选择2023年3月－2025年3月于该院行结肠镜检查的患者660例，采用随机数表法将患者分为NBI组、反转组和联合组，各220名病例。NBI组在结肠镜检查过程中采用NBI，反转组采用结肠镜反转技术，联合组采用NBI联合反转技术。比较3组右半结肠息肉样病变检出率。对所有检出的息肉取组织送病理学检查，以病理结果为最终依据，将息肉划分为肿瘤性和非肿瘤性两类。评估3种检查手段在右半结肠息肉样病变诊断中的准确性。结果 联合组再次检出的肿瘤性息肉及息肉合计（肿瘤性+非肿瘤性）的检出率，总检出的肿瘤性息肉及息肉合计（肿瘤性+非肿瘤性）的检出率明显高于反转组，差异均有统计学意义（P < 0.0167）；NBI组再次检出的肿瘤性息肉和息肉合计（肿瘤性+非肿瘤性）的检出率明显高于反转组，差异均有统计学意义（P < 0.0167）。联合组 < 5 mm息肉和平坦型息肉检出率明显高于反转组（P < 0.0167）。在右半结肠息肉样病变的诊断中，结肠镜NBI的敏感度、特异度和准确度分别为93.22%、95.59%和94.49%，结肠镜反转技术分别为68.97%、89.58%和78.30%，两者联合分别为97.10%、98.61%和97.87%。其中，结肠镜NBI和两者联合的敏感度和准确度明显高于结肠镜反转技术，差异均有统计学意义（P < 0.0167）。结论 结肠镜NBI联合反转技术能有效提高右半结肠息肉样病变检出率，其诊断效能明显高于单用结肠镜反转技术。

Abstract:

Objective To investigate the effect of colonoscopy narrow band imaging (NBI) combined with reversal technique on improving the detection rate of polypoid lesions in the right colon and the diagnostic efficacy of the combination of the two techniques.Methods 660 patients who underwent colonoscopy from March 2023 to March 2025 were selected. The patients were divided into the NBI group, the reversal group and the combined group by the random number table method, with 220 cases in each group. Diagnostic protocols varied across groups: the NBI group underwent NBI during colonoscopy, the reversal group received the colonic reversal technique, while the combined group experienced both NBI and reversal techniques concurrently. Comparative analysis focused on polypoid lesion detection rates within the right colonic segments among all three groups. All the detected polyps were taken for pathological examination, and the polyps were divided into neoplastic polyps and non-neoplastic polyps. To compare the diagnostic efficacy of three methods for right colon polypoid lesions.Results The detection rates of re-detected neoplastic polyps, total re-detected polyps (neoplastic + non-neoplastic), total detected neoplastic polyps and total detected polyps (neoplastic + non-neoplastic) in the combined group were significantly higher than those in the reversal group (P < 0.0167). The detection rates of re-detected neoplastic polyps and the total number of recurrent polyps (neoplastic + non-neoplastic) in the NBI group were significantly higher than those in the reversal group (P < 0.0167). The detection rates of polypoid lesions < 5 mm and flat polypoid lesions in the combined group were significantly higher than those in the inversion group (P < 0.0167). For detecting polypoid abnormalities in the right colon, NBI demonstrated diagnostic performance metrics of 93.22% sensitivity, 95.59% specificity, and 94.49% accuracy. The colonoscopic reversal method yielded values of 68.97% sensitivity, 89.58% specificity, and 78.30% accuracy when examining similar lesions. When combining both NBI and reversal techniques, the composite evaluation achieved superior results with 97.10% sensitivity, 98.61% specificity, and 97.87% diagnostic accuracy for right colonic polypoid lesions. The sensitivity and accuracy of NBI and NBI+reversal technique in the diagnosis of polypoid lesions in the right colon were significantly higher than those of the reversal technique (P < 0.0167).Conclusion Colonoscopy NBI combined with reversal technique can effectively increase the detection rate of polypoid lesions in the right colon, and its diagnostic efficacy is significantly higher than that of colonoscopy reversal technique alone.