摘要/Abstract

摘要： 目的 ·研究非放大内镜下窄带成像技术（narrow-band imaging，NBI）结合 NBI诊断结直肠病变的国际分型（NBI International Colorectal Endoscopic Criteria，NICE分型）诊断结直肠病变的价值，及临床使用“不切除”和 “切除 -丢弃”策略的可行性和安全性。方法 ·选取 2017年 5月— 12月因各种原因在上海交通大学医学院附属仁济医院内镜中心行结肠镜检查，并在检查过程中发现病变的患者。所有入组患者均由指定的 2名医师中的任意一位利用 NBI结合非放大内镜完成检查，并使用 NICE分型诊断结直肠病变，同时记录每个病变医师诊断的确信度。内镜诊断结果与病理学检查结果进行对比分析，计算医师诊断的准确率和确信率，以及该诊断方法鉴别肿瘤及非肿瘤病变的敏感度、特异度、阳性预测值和阴性预测值。最后分析临床使用“不切除”和“切除 -丢弃”策略的可行性、安全性及可节省开支。结果 ·共入组 636例患者，发现病变 764处。使用 NICE分型诊断病变的总体准确率为 84.95%，诊断确信率为 81.68%；鉴别浅表肿瘤及非肿瘤病变的敏感度为 91.77%，特异度为 67.68%，阳性预测值为 88.69%，阴性预测值为 74.86%。对于高诊断确信度的结直肠微小病变（最大直径≤ 5 mm），诊断准确率为 94.98%；对于高诊断确信度的直乙结肠微小病变（最大直径 ≤ 5 mm），阴性预测值为 96.25%。上述 2种高诊断确信度的微小病变分别达到使用 “切除 -丢弃 ”和 “不切除 ”策略的要求，共可节省医疗费用 165 490元，“切除 -丢弃”策略的肿瘤病变漏诊率为 0，而“不切除”策略的漏诊率为 3.75%。结论 ·非放大内镜下 NBI结合 NICE分型可以较好地鉴别结直肠肿瘤和非肿瘤病变，对于高诊断确信度的结直肠微小病变及直乙结肠微小病变可能分别达到使用“切除 -丢弃”和“不切除”策略的要求。
关键词: 消化内镜, 结肠镜, 结直肠病变, 窄带成像, &, ldquo, 切除 -丢弃&, rdquo, 策略, &, ldquo, 不切除&, rdquo, 策略
Abstract:
Objective · To evaluate narrow-band imaging (NBI) without magnifying in the diagnosis of colorectal lesionsNBI International Colorectal Endoscopic Criteria (NICE classification), and analyze the safety and practicability of “do-not-resect” and “resect and discard” policies in clinical practice. Methods · The patients undergoing screening or surveillance colonoscopy, who were found colorectal lesions in the examination, May to December in 2017 were enrolled. All the patients were examinedNBI without magnifyingany of the designated two physicians. NICE classification was used to diagnose colorectal lesions, and the diagnostic confidence of each lesion was recorded. The results of endoscopy were compared with those of pathology, and the accuracy rate and the confidence rate of diagnosis were calculated. The sensitivity, specificity, positive predictive value and negative predictive value of the diagnostic method for differentiating superficial tumors non-tumors were also calculated. Finally, the feasibility, safety and cost savings of using “do-not-resect” and “resect and discard” policies in clinic were analyzed. Results · A total of 764 lesions were detected in the 636 enrolled patients. The overall accuracy of NICE classification was 84.95% and the diagnostic confidence rate was 81.68%. The sensitivity, specificity, positive predictive value and negative predictive value for differentiating tumors non-tumors were 91.77%, 67.68%, 88.69%, and 74.86%, respectively. The diagnostic accuracy of diminutive colorectal lesions ( ≤ 5 mm) with high confidence was 94.98%, and the negative predictive value of diminutive rectosigmoid lesions ( ≤ 5 mm) with high confidence was 96.25%. They achieved the criteria of “resect and discard” and “do-not-resect” policies. If “donot-resect” and “resect and discard” policies had been executed in clinical practice, ￥165 490 could have been saved and the omission diagnostic rates of “do-not-resect” and “resect and discard” policies would have been 3.75% and 0, respectively, in this study. Conclusion · It is feasible to NBI without magnifying in differentiating tumors non-tumors. The diminutive colorectal lesions and rectosigmoid lesions with high diagnostic confidence may achieve the criteria of “resect and discard” and “do-not-resect” policies, respectively.
Key words: digestive endoscopy, colonoscopy, colorectal lesion, narrow-band imaging (NBI), &, ldquo, resect and discard&, rdquo, policy, &, ldquo, do-not-resect&, rdquo, policy


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