Rex D K, Bond J H, Feld A D
Indiana University School of Medicine, Indiana University Hospital, Indianapolis, USA.
Am J Gastroenterol. 2001 Apr;96(4):952-7. doi: 10.1111/j.1572-0241.2001.03677.x.
Colonoscopy and polypectomy effectively reduce the incidence and mortality of colorectal cancer, but some patients present with fully developed cancers within 1-4 yr of a colonoscopy that apparently cleared the colon of neoplasia. These events may result in medical-legal action against colonoscopists, generally based on an assumption of negligent technical performance of the procedure. Alternative explanations for the development of interval cancers include variable growth rates of colorectal cancers, the inherent miss rate of the procedure even when optimal examination techniques are used, and the possibility of flat lesions that are not readily detected by standard colonoscopic techniques. This paper discusses issues relevant to reduction of medical-legal risks associated with interval cancers after clearing colonoscopy. These issues include informed consent, documentation of cecal intubation, appropriate description of preparation, documentation of examination time and technique, and attention to potential atypical neoplasms.
结肠镜检查及息肉切除术可有效降低结直肠癌的发病率和死亡率，但有些患者在结肠镜检查显示结肠无瘤变后的1至4年内出现了完全进展的癌症。这些事件可能导致针对结肠镜检查医师的医疗法律诉讼，通常是基于对该操作存在技术过失的假设。间期癌发生的其他解释包括结直肠癌的生长速度不同、即使使用最佳检查技术该操作仍存在固有漏诊率，以及标准结肠镜检查技术不易检测到扁平病变的可能性。本文讨论了与降低结肠镜检查后间期癌相关的医疗法律风险有关的问题。这些问题包括知情同意、盲肠插管记录、准备工作的适当描述、检查时间和技术记录，以及对潜在非典型肿瘤的关注。
