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中华胃肠内镜电子杂志 ›› 2022, Vol. 09 ›› Issue (01) : 30 -35. doi: 10.3877/cma.j.issn.2095-7157.2022.01.018

论著

电子结肠镜进镜操作难度的相关因素研究
杨栋1, 陶克1, 李梦2, 夏研1, 曹婷婷1, 赵瑞虹1, 张建广1, 徐红1,()   
  1. 1. 130021 长春,吉林大学第一医院胃肠内科·内镜中心
    2. 130021 长春,吉林大学第一医院胃结直肠肛门外科
  • 收稿日期:2021-11-22 出版日期:2022-02-15
  • 通信作者: 徐红
  • 基金资助:
    吉林大学第一医院中国光华科技基金项目(JDYYGH2019011)

Study on the related factors of insertion difficulty during colonoscopy

Dong Yang1, Ke Tao1, Meng Li2, Yan Xia1, Tingting Cao1, Ruihong Zhao1, Jianguang Zhang1, Hong Xu1,()   

  1. 1. Department of Gastroenterology
    2. Department of Gastrointestinal and Anal Surgery, The First Hospital of Jilin University, Changchun 130021, China
  • Received:2021-11-22 Published:2022-02-15
  • Corresponding author: Hong Xu
引用本文:

杨栋, 陶克, 李梦, 夏研, 曹婷婷, 赵瑞虹, 张建广, 徐红. 电子结肠镜进镜操作难度的相关因素研究[J/OL]. 中华胃肠内镜电子杂志, 2022, 09(01): 30-35.

Dong Yang, Ke Tao, Meng Li, Yan Xia, Tingting Cao, Ruihong Zhao, Jianguang Zhang, Hong Xu. Study on the related factors of insertion difficulty during colonoscopy[J/OL]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2022, 09(01): 30-35.

目的

通过对肠镜检查的大宗病例进行分析研究,指导临床对拟检患者进镜难度预评估与检查前准备。

方法

回顾性分析2019年4月至2020年4月吉林大学第一医院胃肠内科·内镜中心所建立的普通肠镜检查数据库共586例病例,根据内镜医生检查过程中对进镜难度的主观评估结果分为E(easy,容易)组与D(difficult,困难)组,对两组间相关临床数据进行对比,并对结肠镜进镜难度相关危险因素包括:主诉是否便秘、口服泻药种类、性别组成、年龄、体质指数(BMI)、既往腹部手术史、进镜时肠道清洁程度进行单因素及多因素分析,进而构建预测结肠镜进镜操作难易程度的列线图模型。

结果

E组患者与D组患者相比进镜时间更短(10 vs 15 min,P<0.001),需要额外注水来润滑肠道从而降低进镜难度缓解患者疼痛的比例更低(27.7% vs 92.7%,P<0.001),到达回盲部的比例更高(100 % vs 96.3%,P<0.001),同时E组患者较D组患者疼痛视觉模糊评分(VAS)更低,痛苦更小(4 vs 5,P<0.001)。单因素分析发现,两组在主诉是否便秘、口服泻药种类、性别组成、年龄、BMI、既往腹部手术史方面存在统计学差异(P均<0.05),而在进镜时肠道准备清洁程度方面无统计学差异(P≥0.05)。进一步行Logistic回归分析结果显示,主诉便秘、BMI低、口服磷酸钠盐口服溶液、腹部手术史是进镜困难的独立危险因素(P均<0.05),综合上述独立危险因素构建了预测结肠镜进镜操作难易程度的列线图模型。

结论

主诉便秘、BMI低、口服磷酸钠盐口服溶液、腹部手术史是进镜困难的独立危险因素,可利用基于上述独立危险因素构建的列线图模型于检查前预测出受检者肠镜进镜操作的难度,从而指导该结肠镜检查的相关准备。

Objective

To guide the pre evaluation of the difficulty and preparation before the examination of colonoscopy by analyzing the large number of cases.

Methods

A total of 586 cases of unsedated colonoscopy in the endoscopy center of the First Hospital of Jilin University from April 2019 to April 2020 were retrospectively analyzed. According to the evaluation results of the difficulty of colonoscopic insertion, They were divided into easy group (group E) and difficult group (group D). The nomogram model for difficulty of colonoscopic insertion was constructed.

Results

Compared with the group D, the group E had shorter insertion time (10 vs 15 min, P< 0.001), the proportion of cases requiring additional water to lubricate the lumen was lower (27.7% vs 92.7%, P< 0.001), and the proportion of cecal intubation was higher (100 % vs 96.3%, P<0.001). The VAS score of group E was lower than that of group D (4 vs 5, P< 0.001). The independent risk factors were constipation, low BMI, the use of oral sodium phosphate solution, and history of abdominal surgery (P< 0.05). The nomogram model was constructed to predict the difficulty of colonoscopy, based on these independent risk factors.

Conclusion

The score for difficulty of colonoscopic insertion can be estimated by scoring all independent risk factors, so as to guide preparations for the examination of colonoscopy.

表1 两组患者进镜情况对比[n(%)]
表2 进镜难度危险因素单因素分析[n(%)]
表3 各临床特征预测进镜难度的Logistic多因素回归分析
图5 肠镜进镜操作难易程度的列线图预测模型注:首行得分为0~100分的评分标尺,下方各项结果与首行刻度对应;主诉便秘0为否,1为是;BMI=体重(kg)÷身高(m)2;手术史0为无,1为有(腹部手术史根据本研究纳入排除标准,结直肠及阑尾切除手术除外);泻药种类1为聚乙二醇电解质散,2为磷酸钠盐口服溶液;总分为上述四项对应首行刻度评分的总和;总分与进镜难度评分由易到难(0.05-0.95)相对应
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