本文選題：光學(xué)增強內(nèi)鏡　切入點：腺瘤　出處：《山東大學(xué)》2017年碩士論文

【摘要】：背景與目的:結(jié)直腸癌是世界上最常見的惡性腫瘤之一,它嚴(yán)重威脅著人類的健康,其發(fā)病率呈現(xiàn)出逐漸增加的趨勢。結(jié)腸鏡檢查被廣泛應(yīng)用于結(jié)腸腫瘤的篩查,通過內(nèi)鏡下早期發(fā)現(xiàn)并且切除結(jié)直腸腺瘤被認為是預(yù)防結(jié)直腸癌的最有效的方法。但有研究發(fā)現(xiàn),在普通結(jié)腸鏡檢查時,會漏診15-32%的腺瘤。漏診的原因可能有技術(shù)方面的原因,例如退鏡時間過快不能做到細致的觀察、腺瘤被腸道皺襞遮擋等,也有可能與設(shè)備有關(guān),例如平坦型較小的病變由于外形不顯著以及與周圍腸粘膜對比性差而被忽視。近年來,新型內(nèi)鏡技術(shù)不斷出現(xiàn),并且用于提高腺瘤檢出率的研究中,例如窄帶成像技術(shù)、最佳譜帶成像系統(tǒng)等,但結(jié)論不一,以上技術(shù)未能廣泛應(yīng)用到結(jié)腸鏡的篩查中,很重要的原因是以上電子染色內(nèi)鏡技術(shù)在腸腔中呈現(xiàn)出較暗的視野,這限制了它們優(yōu)勢的發(fā)揮。光學(xué)增強內(nèi)鏡(Optical Enhancement,OE)是一種新型光學(xué)染色內(nèi)鏡,能增加正常腸道黏膜與異常病變的對比度,并且可以在腸腔中提供較亮的視野。本研究即通過觀察不同患者分別使用光學(xué)增強內(nèi)鏡或者高清白光內(nèi)鏡進行腸道檢查時的檢查效果,探究與高清白光內(nèi)鏡相比,光學(xué)增強內(nèi)鏡能否提高腺瘤的檢出率。方法:在2016年8月至2016年12月期間,我們納入符合納入標(biāo)準(zhǔn)的前來行結(jié)腸鏡檢查的患者,研究中共有302名患者,隨機分為2組,其中光學(xué)增強內(nèi)鏡組152人,高清白光內(nèi)鏡組150人,行結(jié)腸鏡檢查時,兩組患者均以高清白光內(nèi)鏡模式進鏡,到達回盲部后退鏡觀察,退鏡時光學(xué)增強內(nèi)鏡組打開OE2模式退鏡觀察,直至檢查結(jié)束,高清白光內(nèi)鏡組通過高清白光內(nèi)鏡模式退鏡觀察。記錄患者的基本資料、腸道準(zhǔn)備情況、退鏡時間、發(fā)現(xiàn)的息肉,以及息肉的特點等,對于發(fā)現(xiàn)的息肉取病理,比較兩組間發(fā)現(xiàn)息肉及腺瘤的個數(shù),比較兩組間息肉及腺瘤的檢出率,比較兩組發(fā)現(xiàn)腺瘤的特點的不同。結(jié)果:光學(xué)增強內(nèi)鏡組與高清白光內(nèi)鏡組間患者的男女比例、年齡、檢查指征、麻醉人數(shù)比、腸道準(zhǔn)備情況及退鏡時間等均無明顯差異,在光學(xué)增強內(nèi)鏡組中,至少有1枚息肉的患者為81人,至少有1枚腺瘤的患者為59人,在高清白光內(nèi)鏡組中,至少有1枚息肉的患者為68人,至少有1枚腺瘤的患者為44人,光學(xué)增強內(nèi)鏡組中的息肉及腺瘤檢出率均高于高清白光內(nèi)鏡組(息肉:53.3%vs 45.3%,p=0.167;腺瘤:38.8%vs 29.3%,p=0.082),但是均未到達統(tǒng)計學(xué)差異。光學(xué)增強內(nèi)鏡組發(fā)現(xiàn)無蒂型腺瘤68枚,亞蒂型腺瘤36枚,帶蒂型腺瘤13枚,高清白光內(nèi)鏡組發(fā)現(xiàn)無蒂型腺瘤39枚,亞蒂型腺瘤35枚,帶蒂型腺瘤15枚,光學(xué)增強內(nèi)鏡組發(fā)現(xiàn)無蒂型腺瘤高于高清白光內(nèi)鏡組(p=0.042),兩組間亞蒂型腺瘤及帶蒂型腺瘤無明顯差異。光學(xué)增強內(nèi)鏡組發(fā)現(xiàn)直徑6mm的腺瘤76枚,直徑6-10mm的腺瘤25枚,直徑10mm的腺瘤16枚,高清白光內(nèi)鏡組發(fā)現(xiàn)直徑6mm的腺瘤45枚,直徑6-10mm的腺瘤28枚,直徑10mm的腺瘤16枚,光學(xué)增強內(nèi)鏡組發(fā)現(xiàn)直徑6mm的腺瘤高于高清白光內(nèi)鏡組(p=0.038),兩組間發(fā)現(xiàn)直徑6-10mm的腺瘤及10mm的腺瘤無明顯差異。連續(xù)比較兩種內(nèi)鏡模式在第一個、第二個、第三個、第四個75名受試者中腺瘤的檢出率,光學(xué)增強內(nèi)鏡具有較為較為恒定的表現(xiàn)(39.5%,34.2%,42.1%,39.5%),而高清白光內(nèi)鏡組表現(xiàn)出逐漸提高的趨勢(23.7%,29.7%,31.6%,32.4%)。結(jié)論:1.光學(xué)增強內(nèi)鏡比高清白光內(nèi)鏡有更高的息肉和腺瘤檢出率,但是未能達到統(tǒng)計學(xué)差異。2.在無蒂型腺瘤和微小腺瘤檢出方面,光學(xué)增強內(nèi)鏡優(yōu)于高清白光內(nèi)鏡。3.光學(xué)增強內(nèi)鏡學(xué)習(xí)方便,易于掌握,在檢出腺瘤方面學(xué)習(xí)曲線短于高清白光內(nèi)鏡。
[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.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.34

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