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Article(id=1322210869887484783, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322210840242139234, articleNumber=null, orderNo=null, doi=10.16016/j.2097-0927.202412022, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1733328000000, receivedDateStr=2024-12-05, revisedDate=1737302400000, revisedDateStr=2025-01-20, acceptedDate=null, acceptedDateStr=null, onlineDate=1793169236871, onlineDateStr=2026-10-28, pubDate=1744646400000, pubDateStr=2025-04-15, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793169236871, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793169236871, creator=13701087609, updateTime=1793169236871, updator=13701087609, issue=Issue{id=1322210840242139234, tenantId=1146029695717560320, journalId=1319373162502258839, year='2025', volume='47', issue='7', pageStart='629', pageEnd='748', issueExtLink='null', onlineDate='null', pubDate='1744646400000', pubDateStr='2025-04-15', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793169229803, creator='13701087609', updateTime=1793325214855, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322865089049383299, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322210840242139234, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322865089049383300, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322210840242139234, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=728, endPage=733, ext={EN=ArticleExt(id=1322210871686841200, articleId=1322210869887484783, tenantId=1146029695717560320, journalId=1319373162502258839, language=EN, title=Correlation between biopsy rate and positive rate of biopsy in assessment of diagnostic competence in endoscopists, columnId=1320435174995772212, journalTitle=Journal of Army Medical University, columnName=Clinical Medicine, runingTitle=null, highlight=null, articleAbstract=
Objective‍

To explore whether the biopsy rate and the positive rate of biopsy during colonoscopy can serve as effective indicators for evaluating the diagnostic proficiency of endoscopists.

Methods‍

Total fifteen endoscopists from the First Affiliated Hospital of Army Military Medical University, Guiqian International General Hospital and No. 958 Hospital of PLA Army were enrolled and served as the study subjects. According to their years of experience, gender and working hours, they were divided into a senior group (n=8) and a junior group (n=7), a male group (n=9) and a female group (n=6), and a morning period (08:00-12:00) and an afternoon period (13:00-18:00). The data of all patients examined by the aforementioned endoscopists between January 2023 and December 2023 were collected, including the basic demographics, colonoscopic results, biopsy outcomes and pathological diagnoses of the patients. ANOVA was used to analyze the differences in the biopsy rate and positive rate of biopsy existed among the endoscopists of different years of experience, gender and working at different periods (morning and afternoon). Additionally, multivariate logistic regression analysis was employed to identify the independent risk factors associated with positive rates of biopsy.

Results‍

The senior group had significantly lower biopsy rate [(5.73±0.81)% vs (6.89±0.97)%], but obviously higher positive rate of biopsy [(53.52±3.87)% vs (33.70±7.85)%] than the junior group (both P<0.01). The biopsy rate was notably higher during the morning working time period than the afternoon working time period in all the endoscopits [(6.76±1.11)% vs (5.53±1.57)%, P<0.05]. Logistic regression analysis showed that the years of experience [(53.52±3.87)% vs (33.70±7.85)%, OR=92.187, 95%CI: 3.118~2 725.366, P<0.01) and working time [(48.35±10.50)% vs (37.80±10.65)%, OR=20.885, 95%CI: 1.266~344.602, P<0.05) were influencing factors for positive rate of biopsy.

Conclusion‍

The biopsy rate is low and positive rate of biopsy is high among the senior experienced endoscopists, while, opposite results are seen in the junior experienced clinicians, indicating correlation of biopsy rate and positive rate of biopsy with diagnostic proficiency of endoscopists.

, authors=Wen CHEN1, Hengyu WANG1, Li RAO3, Xue ZHANG2, Hong YANG2, Qian ZHOU4, Lei CHEN1, authorsList=Wen CHEN, Hengyu WANG, Li RAO, Xue ZHANG, Hong YANG, Qian ZHOU, Lei CHEN, authorCompany=null, correspAuthors=Lei CHEN, authorNote=null, correspAuthorsNote=null, copyrightStatement=© 2025 Journal of Army Medical University, copyrightOwner=Editorial Office of Journal of Army Medical University, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322210872068522865, articleId=1322210869887484783, tenantId=1146029695717560320, journalId=1319373162502258839, language=CN, title=活检率与活检阳性率在内镜医师诊断水平评估中的相关性研究, columnId=1322185541475488183, journalTitle=陆军军医大学学报, columnName=临床医学, runingTitle=null, highlight=null, articleAbstract=
目的

探究结肠镜检查中，活检率和活检阳性率是否可作为评估内镜医师诊断水平的有效指标。

方法

选取陆军军医大学第一附属医院消化内镜中心、贵黔国际总医院消化内镜中心、中国人民解放军陆军第九五八医院消化内镜中心的15名内镜医师作为研究对象。根据年资分为高年资组（n=8）和低年资组（n=7），根据性别分为男医师组（n=9）和女医师组（n=6），根据工作时间分为上午时段（8：00~12：00）和下午时段（13：00~18：00）。收集其在2023年01月至2023年12月期间检查的所有患者数据，共纳入28 949名检查病例。采用单因素方差分析，探讨内镜医师年资、性别以及不同工作时段对活检率、活检阳性率之间的差异。同时，采用多因素Logistic回归分析影响活检阳性率的独立危险因素。

结果

高年资组活检率低于低年资组［（5.73±0.81）% vs （6.89±0.97）%，P<0.01］，但活检阳性率高于低年资组［（53.52±3.87）% vs （33.70±7.85）%，P<0.01］；所有医师组上午时段活检率高于下午时段结肠镜检查活检率［（6.76±1.11）% vs （5.53±1.57）%，P<0.05］；Logistic回归分析显示医师年资［（53.52±3.87）% vs （33.70±7.85）%，P<0.01，OR=92.187，95%CI：3.118~2725.366］、工作时间段［（48.35±10.50）% vs （37.80±10.65）%，P<0.05，OR=20.885，95%CI：1.266~344.602］是活检阳性率的影响因素。

结论

高年资内镜医师的活检率低而活检阳性率高，低年资活检率高但活检阳性率低，表明活检率、活检阳性率与内镜医师诊断水平相关。

, authors=陈稳1, 王珩宇1, 饶莉3, 张雪2, 杨红2, 周倩4, 陈磊1, authorsList=陈稳, 王珩宇, 饶莉, 张雪, 杨红, 周倩, 陈磊, authorCompany=null, correspAuthors=陈磊, authorNote=

作者贡献声明

陈稳：实验设计、文章撰写；陈稳、王珩宇：数据统计分析、作图；饶莉、张雪、杨红：收集数据；周倩：整理数据；陈磊：研究指导、论文审阅、经费支持

, correspAuthorsNote=
陈磊，E-mail：
CHEN Lei，E-mail：
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分类活检率上午时段活检率下午时段活检率
高年资组（n=8）5.73±0.81a6.15±0.79a4.94±1.78b
低年资组（n=7）6.89 ± 0.977.46±1.036.20±1.01
所有医师组（n=15）-6.76±1.11c5.53±1.57
男医师组（n=9）5.95 ± 0.63--
女医师组（n=6）6.76 ± 1.39--
), ArticleFig(id=1322210878586471340, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210869887484783, language=CN, label=表1, caption=

内镜医师活检率相关因素分析（x¯±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
分类活检率上午时段活检率下午时段活检率
高年资组（n=8）5.73±0.81a6.15±0.79a4.94±1.78b
低年资组（n=7）6.89 ± 0.977.46±1.036.20±1.01
所有医师组（n=15）-6.76±1.11c5.53±1.57
男医师组（n=9）5.95 ± 0.63--
女医师组（n=6）6.76 ± 1.39--
), ArticleFig(id=1322210878905238445, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210869887484783, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
分组活检阳性率上午时段活检阳性率下午时段活检阳性率
高年资组（n=8）53.52±3.87a55.82±3.48b44.84±6.68c
低年资组（n=7）33.70±7.8539.81±9.1529.75±8.40
所有医师组（n=15）-48.35±10.50d37.80±10.65
男医师组（n=9）44.91±14.86--
女医师组（n=6）43.32±5.76--
), ArticleFig(id=1322210880566182831, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210869887484783, language=CN, label=表2, caption=

内镜医师活检阳性率相关因素分析（x¯±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
分组活检阳性率上午时段活检阳性率下午时段活检阳性率
高年资组（n=8）53.52±3.87a55.82±3.48b44.84±6.68c
低年资组（n=7）33.70±7.8539.81±9.1529.75±8.40
所有医师组（n=15）-48.35±10.50d37.80±10.65
男医师组（n=9）44.91±14.86--
女医师组（n=6）43.32±5.76--
), ArticleFig(id=1322210880633291696, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210869887484783, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
因素活检率OR（95%CI）P活检阳性率OR（95%CI）P
资历
高年资0.260（0.022~3.122）0.28892.187（3.118~2725.366）0.009
低年资1.0001.000
性别0.5080.343
男性0.426（0.034~5.314）0.274（0.019~3.985）
女性1.0001.000
工作时间0.1550.034
上午5.777（0.516~64.669）20.885（1.266~344.602）
下午1.0001.000
), ArticleFig(id=1322210880704594865, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322210869887484783, language=CN, label=表3, caption=

影响内镜医师活检率及活检阳性率的多因素Logistic分析

, figureFileSmall=null, figureFileBig=null, tableContent=
因素活检率OR（95%CI）P活检阳性率OR（95%CI）P
资历
高年资0.260（0.022~3.122）0.28892.187（3.118~2725.366）0.009
低年资1.0001.000
性别0.5080.343
男性0.426（0.034~5.314）0.274（0.019~3.985）
女性1.0001.000
工作时间0.1550.034
上午5.777（0.516~64.669）20.885（1.266~344.602）
下午1.0001.000
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活检率与活检阳性率在内镜医师诊断水平评估中的相关性研究
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陈稳 1 , 王珩宇 1 , 饶莉 3 , 张雪 2 , 杨红 2 , 周倩 4 , 陈磊 1
陆军军医大学学报 | 临床医学 2025,47(7): 728-733
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陆军军医大学学报 |临床医学 2025 , 47 (7) : 728 -733
活检率与活检阳性率在内镜医师诊断水平评估中的相关性研究
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陈稳1, 王珩宇1, 饶莉3, 张雪2, 杨红2, 周倩4, 陈磊1
作者信息
  • 1陆军军医大学（第三军医大学）第一附属医院消化内科
  • 2重庆；中国人民解放军陆军第九五八医院消化内科
  • 3重庆；忠县人民医院消化内科
  • 4重庆；贵黔国际总医院消化内科
通讯作者:
陈磊，E-mail：
CHEN Lei，E-mail：
作者简介:

作者贡献声明

陈稳：实验设计、文章撰写；陈稳、王珩宇：数据统计分析、作图；饶莉、张雪、杨红：收集数据；周倩：整理数据；陈磊：研究指导、论文审阅、经费支持

Correlation between biopsy rate and positive rate of biopsy in assessment of diagnostic competence in endoscopists
Wen CHEN1, Hengyu WANG1, Li RAO3, Xue ZHANG2, Hong YANG2, Qian ZHOU4, Lei CHEN1
Affiliations
  • 1Department of Gastroenterology，First Affiliated Hospital，Army Medical University （Third Military Medical University），Chongqing
  • 2Department of Gastroenterology，No. 958 Hospital of PLA Army，Chongqing
  • 3Department of Gastroenterology，Zhongxian People’s Hospital，Chongqing
  • 4Department of Gastroenterology，Guiqian International Hospital，Guiyang，Guizhou，China
出版时间: 2025-04-15 doi: 10.16016/j.2097-0927.202412022
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摘要
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目的

探究结肠镜检查中，活检率和活检阳性率是否可作为评估内镜医师诊断水平的有效指标。

方法

选取陆军军医大学第一附属医院消化内镜中心、贵黔国际总医院消化内镜中心、中国人民解放军陆军第九五八医院消化内镜中心的15名内镜医师作为研究对象。根据年资分为高年资组（n=8）和低年资组（n=7），根据性别分为男医师组（n=9）和女医师组（n=6），根据工作时间分为上午时段（8：00~12：00）和下午时段（13：00~18：00）。收集其在2023年01月至2023年12月期间检查的所有患者数据，共纳入28 949名检查病例。采用单因素方差分析，探讨内镜医师年资、性别以及不同工作时段对活检率、活检阳性率之间的差异。同时，采用多因素Logistic回归分析影响活检阳性率的独立危险因素。

结果

高年资组活检率低于低年资组［（5.73±0.81）% vs （6.89±0.97）%，P<0.01］，但活检阳性率高于低年资组［（53.52±3.87）% vs （33.70±7.85）%，P<0.01］；所有医师组上午时段活检率高于下午时段结肠镜检查活检率［（6.76±1.11）% vs （5.53±1.57）%，P<0.05］；Logistic回归分析显示医师年资［（53.52±3.87）% vs （33.70±7.85）%，P<0.01，OR=92.187，95%CI：3.118~2725.366］、工作时间段［（48.35±10.50）% vs （37.80±10.65）%，P<0.05，OR=20.885，95%CI：1.266~344.602］是活检阳性率的影响因素。

结论

高年资内镜医师的活检率低而活检阳性率高，低年资活检率高但活检阳性率低，表明活检率、活检阳性率与内镜医师诊断水平相关。

结肠镜检查  /  活检率  /  活检阳性率  /  诊断水平
Objective‍

To explore whether the biopsy rate and the positive rate of biopsy during colonoscopy can serve as effective indicators for evaluating the diagnostic proficiency of endoscopists.

Methods‍

Total fifteen endoscopists from the First Affiliated Hospital of Army Military Medical University, Guiqian International General Hospital and No. 958 Hospital of PLA Army were enrolled and served as the study subjects. According to their years of experience, gender and working hours, they were divided into a senior group (n=8) and a junior group (n=7), a male group (n=9) and a female group (n=6), and a morning period (08:00-12:00) and an afternoon period (13:00-18:00). The data of all patients examined by the aforementioned endoscopists between January 2023 and December 2023 were collected, including the basic demographics, colonoscopic results, biopsy outcomes and pathological diagnoses of the patients. ANOVA was used to analyze the differences in the biopsy rate and positive rate of biopsy existed among the endoscopists of different years of experience, gender and working at different periods (morning and afternoon). Additionally, multivariate logistic regression analysis was employed to identify the independent risk factors associated with positive rates of biopsy.

Results‍

The senior group had significantly lower biopsy rate [(5.73±0.81)% vs (6.89±0.97)%], but obviously higher positive rate of biopsy [(53.52±3.87)% vs (33.70±7.85)%] than the junior group (both P<0.01). The biopsy rate was notably higher during the morning working time period than the afternoon working time period in all the endoscopits [(6.76±1.11)% vs (5.53±1.57)%, P<0.05]. Logistic regression analysis showed that the years of experience [(53.52±3.87)% vs (33.70±7.85)%, OR=92.187, 95%CI: 3.118~2 725.366, P<0.01) and working time [(48.35±10.50)% vs (37.80±10.65)%, OR=20.885, 95%CI: 1.266~344.602, P<0.05) were influencing factors for positive rate of biopsy.

Conclusion‍

The biopsy rate is low and positive rate of biopsy is high among the senior experienced endoscopists, while, opposite results are seen in the junior experienced clinicians, indicating correlation of biopsy rate and positive rate of biopsy with diagnostic proficiency of endoscopists.

colonoscopy  /  biopsy rate  /  positive rate of biopsy  /  diagnostic level
陈稳, 王珩宇, 饶莉, 张雪, 杨红, 周倩, 陈磊. 活检率与活检阳性率在内镜医师诊断水平评估中的相关性研究. 陆军军医大学学报, 2025 , 47 (7) : 728 -733 . DOI: 10.16016/j.2097-0927.202412022
Wen CHEN, Hengyu WANG, Li RAO, Xue ZHANG, Hong YANG, Qian ZHOU, Lei CHEN. Correlation between biopsy rate and positive rate of biopsy in assessment of diagnostic competence in endoscopists[J]. Journal of Army Medical University, 2025 , 47 (7) : 728 -733 . DOI: 10.16016/j.2097-0927.202412022
正文
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结直肠癌（colorectal cancer，CRC）是一种全球范围内常见的恶性肿瘤，一般发现较晚，且预后较差［1］。根据国家癌症中心最新公布的数据，结直肠癌在我国的发病率仅次于肺癌，且发病率和死亡率呈现出上升趋势［2］，早期发现和治疗对于提升患者的生存率具有至关重要的作用。结肠镜检查是目前结直肠癌筛查的金标准［3-4］，其检查质量直接影响到疾病的早期发现率和诊断的准确性。然而，受限于内镜医师技术水平、肠道准备质量及患者解剖结构差异等因素，仍存在一定漏诊率。既往研究表明，由于内镜医师技术水平的差异，存在一定比例的结直肠息肉可能会被忽视［5-7］。因此，加强结肠镜质量控制体系构建，将有效提升下消化道疾病诊疗水平，对改善患者预后具有重要临床意义［8-9］。
活组织病理检查（活检）作为结肠镜检查中不可或缺的一环，其重要性不言而喻。其镜下诊断和病理诊断的符合程度（阳性率）的高低直接反映了内镜医师的诊断能力和检查质量，对于患者的治疗和预后具有至关重要的作用。JANUSZEWICZ等［10］进行了一项以内镜医师活检率作为门诊胃镜检查质量指标的一项多中心队列研究，研究了内镜医师采集活检样本的异质性，并分析内镜医师活检率（endoscopist biopsy rate，EBR）与胃黏膜癌前病变（gastric premalignant condition，GPC）检出和胃癌（gastric cancer，GC）漏诊率之间的相关性。研究发现，不同组内镜医师的活检率差异很大，并且与胃癌前病变检出率和胃癌漏诊率相关。拥有较高EBR的内镜医生（43.8%）与EBR较低组相比，漏诊癌症的风险较低（OR：0.44，，95%CI：0.20~1.00，P=0.049），与现实中多取活检能减少漏诊的理念相符合。
尽管肠道肿瘤性病变在形态学特征辨识方面较胃肿瘤性病变更具优势，但诊断的金标准仍需依赖活检病理诊断。理论上，内镜医师的临床经验与操作水平直接影响结肠镜检查的活检率与阳性率，即经验丰富的医师能更精准识别可疑肿瘤性病变并规范取样。活检率与阳性率能直接反映内镜医师的操作效能与诊断准确性。因此，本研究拟通过分析内镜医师结肠镜检查中活检率、阳性率与其操作熟练度及不同工作时段的关联性，为优化结肠镜质量控制策略提供科学依据。
1　资料与方法
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1.1　研究对象
筛选来自陆军军医大学第一附属医院消化内镜中心、贵黔国际总医院消化内镜中心以及中国人民解放军陆军第九五八医院消化内科内镜中心的内镜医师作为研究对象。内镜医师纳入标准：①具有全天（上午和下午）结肠镜检查排班；②至少已进行500次结肠镜检查；③平均每天检查例数≥15例。排除标准：①无全天结肠镜检查排班；②未进行结肠镜检查；③因故暂停执业的内镜医师。最终筛选出符合标准的内镜医师共15名。回顾性地搜集这些医师在2023年1月至2023年12月期间检查的所有患者资料（患者的基本信息、结肠镜检查结果、活检样本的分析结果以及病理诊断等详细数据）。患者纳入标准：①肠道准备评分≥6分；②均到达回盲部。患者排除标准：① 住院行结肠镜检查者；②急诊行结肠镜检查者；③既往已明确诊断的患者。最终筛选出符合标准的病例共28 949例。本研究经陆军军医大学第一附属医院伦理委员会批准［（B）KY2024274］。
1.2　研究方法
根据内镜医师连续诊断年限及年结肠镜检查例数分为2组：高年资组（n=8）：连续诊断年限≥5年，且年检查例数≥1 000例；低年资组（n=7）：连续诊断年限<5年，且年检查例数<500例。根据内镜医师性别分为男医师组（n=9）和女医师组（n=6），根据医师工作时间分为上午组：工作时间段（8：00~12：00）和下午组：工作时间段（13：00~18：00）。分别统计出2023年1月至2023年12月期间，每位医师的总检查患者例数、取活检例数、活检阳性例数（病理诊断为结肠癌）、上午工作时间内活检例数与活检阳性例数、下午工作时间内活检例数与活检阳性例数，分别计算出相应的活检率、活检阳性率。确保纳入所有患者充分禁食，肠道准备评分≥6分，均到达回盲部，病理诊断均由高年资的病理医师完成。
本研究活检率定义为活检的结肠镜检查数目/总的结肠镜检查数目×100%；活检阳性定义为经病理诊断为结直肠癌的活检数目/总的活检数目×100%
1.3　统计学分析
采用SPSS 26.0统计软件对收集的数据进行分析。计量资料采用x¯±s表示，计数资料采用例（%）表示。不同组间的数据比较时，如果符合正态分布且方差一致，采用t检验进行分析；如果方差不一致，则采用校正的t检验；若数据不符合正态分布，则采用非参数检验。组间的计数资料比较以χ2检验为主，当理论频数不满足χ2检验的条件时，使用Fisher精确概率法以确保结果的准确性。采用多因素Logistic回归分析来探究活检阳性率的相关危险因素，并以优势比和95%可信区间来展示结果。P<0.05为差异具有统计学意义。
2　结果
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2.1　内镜医师年资、性别以及在不同工作时间活检率的差异性分析。
共纳入28 949例结肠镜检查患者，高年资组总体活检率、上午和下午时段活检率均低于低年资组（P<0.05）。所有医师组上午时段活检率高于下午时段（P<0.05），见表1。
2.2　内镜医师年资、性别以及在不同工作时间活检阳性率的差异性分析。
共计1 820例活检患者中，高年资组总体、上午和下午时段活检阳性率均显著高于低年资组（P<0.01），提示高年资医师结肠镜检查质量优于低年资医师。从时间段上看，高年资组医师中，上午工作时间段活检阳性率显著高于下午（P<0.01），低年资组医师上午工作时间段活检阳性率高于下午，但差异不具有统计学意义。所有医师组上午时段活检阳性率高于下午时段（P<0.05）。见表2。
2.3　内镜医师活检率及活检阳性率相关因素分析。
多因素分析显示医师资历的高低、性别和不同的工作时间均不是活检率的独立相关因素。而针对活检阳性率，医师的资历和其有关，随着医师的资历增加，活检阳性率越高（P<0.01）。内镜医师上午时段较下午有着更高的活检阳性率（P<0.05，表3）。
3　讨论
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结肠镜检查是结直肠癌早期发现和诊断的关键手段，组织病理学检查作为诊断结肠癌的金标准，其质量直接影响患者。尽管结肠镜检查领域已经确立了一些质量指标［11-14］，但针对内镜医师的活检率和活检阳性率的质控指标仍然匮乏，多数指标尚未被验证或因数据质量不佳，难以与患者导向的结果相联系。受结肠镜检查质控指标的启发，本研究提出活检率和活检阳性率作为新的质量评估指标。这两项指标与结肠镜检查中的腺瘤检出率［15］（adenoma detection rate，ADR）相类似，可更直接反映内镜医师对可疑病变的识别能力和精准取样水平。通过多中心回顾性数据验证，本研究为临床提供了基于活检率与阳性率的结肠镜检查质量评估框架。
3.1　活检率与活检阳性率反映内镜医生诊断水平的分析
本研究发现，高年资组医师的活检阳性率显著高于低年资组医师，而活检率显著低于低年资组医师。高年资医师临床经验丰富、操作技巧精细，能准确判断病变是否需活检并精准取样，优化活检策略，降低活检率、减少医疗费用，提高诊断效率，活检阳性率也更高；低年资医师因对病变认识不足，常对可疑“病变”均活检取样，虽活检率高，但增加患者医疗负担与医疗资源浪费。活检率与活检阳性率直接反映内镜医师发现及准确取样疑似病变组织的能力，可衡量结肠镜检查质量。
本研究数据表明，较高的活检阳性率意味着内镜医师具备丰富的经验和较高的专业水平，能够更准确地识别结肠内的病变，从而提高诊断的准确性和早期癌症的发现率，具有更高的结肠镜检查质量。而内镜医师活检率高并不能代表医师的水平高，反而提示要加强对活检率高而活检阳性率低的内镜医师，进行针对性专业培训，提高其识别病变和精准取样的能力，以提高结肠镜检查质量。同时医疗机构应优化设备配置，引进先进的内镜和活检设备，确保图像清晰，操作便捷。制定并执行严格的活检操作流程，确保每次活检都能准确到位。指导患者做好充分的肠道准备，提高视野清晰度，便于发现病变。与病理科紧密合作，提高病理分析的准确性和及时性，以便及时反馈活检结果，指导后续治疗。
3.2　工作时间段对活检阳性率的影响
研究还发现，不同内镜医师在上午工作时间段具有更高的活检阳性率，从临床实际角度考虑，这可能与内镜医师疲劳情况有关，一天的肠镜检查工作中，内镜医师在上午具有更好的精力与注意力，而经过半天的工作，内镜医师可能会出现一定程度的疲劳，影响注意力集中程度、反应速度和判断力，这些因素在结肠镜检查至关重要。尽管已有研究发现，ADR不受全天时段、时间或修改队列位置的影响，即ADR不受内镜医师疲劳程度的影响［16-19］，但大多研究属于回顾性、非随机对照研究，不能完全证明疲劳程度真正影响医师的结肠镜检查质量，故未来需要在前瞻性试验、多中心、大样本研究中进行直接检验。
在医疗领域的结肠镜检查实践中，医师的专注度、情绪状态及累积的临床经验等主观因素对检查质量具有显著影响。尽管目前尚无直接的科研证据表明医师的疲劳程度与活检率、活检阳性率之间存在直接联系，但为了确保结肠镜检查的精确性和可靠性，医师的休息与工作状态至关重要。因此，医疗机构在临床实践中应精心安排内镜医师的工作日程和休息时间，确保医师的工作强度适中，避免过度疲劳。有助于保持其专业素养和工作效率，提升结肠镜检查表现，保障检查质量、患者安全。
3.3　其他相关因素
在结肠镜检查的质量控制中，除内镜医师水平外，肠道清洁度和退镜时间亦是影响活检率和活检阳性率的关键因素。肠道清洁的程度直接影响到内镜医生观察结肠黏膜的清晰度和准确性，不佳的肠道清洁度可能会导致漏检或误诊，增加假阴性结果的风险，从而影响活检率和活检阳性率。因此，在进行结肠镜检查前，应充分指导患者正确进行肠道准备，确保肠道清洁度达到最佳状态。退镜时间的长短与检查过程的顺利程度、病变部位和性质等因素有关，过短的退镜时间可能意味着医生在检查过程中可能无法充分观察结肠各部位，导致漏诊；而过长的退镜时间可能会增加患者的痛苦和风险。因此，合理控制退镜时间对于提高结肠镜检查的准确性和活检率至关重要。此外，高年资和低年资医生所诊疗的患者在年龄、家族史和既往结肠镜检查史等方面的差异，也可能对结果产生影响。在实际临床工作中，这些因素是存在的并且可能对活检率和活检阳性率有显著影响。在未来的研究中，应充分考虑这些指标的影响，进一步探讨上述因素对活检率及活检阳性率影响的具体机制，以指导临床提高检查的准确性和可靠性。
本研究属于回顾性研究，存在一定的局限性。在样本方面，样本量相对较少，且仅来源于3家医院，其代表性存在一定局限；在时间维度上，所涉及的时间跨度较短；此外，研究过程中内镜设备未实现统一标准。尽管存在上述不足，但本研究在临床实践方面仍具备一定的指导价值，可为后续研究及临床工作提供一定的参考依据。第一，提高内镜医师活检阳性率的关键可能是加强医师培训，医师培训与技能提升是提高活检阳性率和诊断水平的关键环节，对于提升结肠镜检查质量、保障患者健康具有重要意义。在实践过程中，应安排资深专家进行指导，及时纠正医生的操作错误，解答他们的疑问。对于年轻医生或经验不足的医生，可以采用导师制，由资深专家一对一地进行指导，帮助他们尽快成长。同时要不断规范检查流程、改善肠道准备、升级检查设备、加强病理协作。第二，医疗机构在组织内镜医师工作时，应避免医生超负荷工作，注重检查质量和工作效率的动态平衡。上述分析结果的综合应用，可以有效提高内镜医师的活检阳性率，进而提高内镜医师的诊断水平，从而更好的提高结肠镜检查质量。

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2025年第47卷第7期
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doi: 10.16016/j.2097-0927.202412022
  • 接收时间：2024-12-05
  • 首发时间：2026-10-28
  • 出版时间：2025-04-15
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  • 收稿日期：2024-12-05
  • 修回日期：2025-01-20
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    1陆军军医大学（第三军医大学）第一附属医院消化内科
    2重庆；中国人民解放军陆军第九五八医院消化内科
    3重庆；忠县人民医院消化内科
    4重庆；贵黔国际总医院消化内科

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