通过内窥镜检查确定溃疡大小的可靠性如何？
How reliable is determination of ulcer size by endoscopy?
作者信息
Sonnenberg A, Giger M, Kern L, Noll C, Study K, Weber K B, Blum A L
出版信息
Br Med J. 1979 Nov 24;2(6201):1322-4. doi: 10.1136/bmj.2.6201.1322.
The suface areas of 23 artificial ulcers in a rubber manikin and of 35 ulcers in 35 consecutive patients admitted for endoscopy of the upper gastrointestinal tract were estimated by six endoscopists. Of the 138 estimations made in the manikin 80% underestimated the true size of the ulcer: the mean (+/- SD) was -29 +/- 40%. The largest and the smallest estimate of the same ulcer by different endoscopists varied on average by a factor of 4.5 +/- 3.8, and the estimates by the same endoscopists of ulcers with the same size varied by a factor of 2.3 +/- 0.6. In the patients the scatter of the estimates was even larger, the mean factor being 7.8 +/- 6.3. Changes in ulcer size are therefore an unsuitable criterion for assessing ulcer healing. Even if consecutive examinations are performed by the same endoscopist, changes in ulcer area smaller than by a factor of 3 are not discernible.
六名内镜医师对橡胶人体模型上的23处人工溃疡以及35例因上消化道内镜检查而连续收治的患者身上的35处溃疡的表面积进行了估计。在对人体模型进行的138次估计中，80%低估了溃疡的实际大小：平均值（±标准差）为-29±40%。不同内镜医师对同一溃疡的最大和最小估计平均相差4.5±3.8倍，同一内镜医师对相同大小溃疡的估计相差2.3±0.6倍。在患者中，估计值的离散度更大，平均倍数为7.8±6.3。因此，溃疡大小的变化不是评估溃疡愈合的合适标准。即使由同一名内镜医师进行连续检查，小于3倍的溃疡面积变化也难以察觉。
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