MacKenzie S, Norrie J, Vella M, Drummond I, Walker A, Molloy R, Galloway D J, O'Dwyer P J
University Department of Surgery, Western Infirmary and Gartnavel General Hospital, Glasgow, UK.
Br J Surg. 2003 Aug;90(8):941-7. doi: 10.1002/bjs.4212.
Referral of patients with large bowel symptoms is common and increasing. Currently most of these referrals are assessed at an outpatient clinic to determine the need and priority for investigation.
Over 21 months, 1131 patients referred by the general practitioner with large bowel symptoms were randomized. Patients in the consultant-led group were assessed by surgeons with a colorectal interest while those in the open access group underwent colonoscopy if they were 55 years or older and flexible sigmoidoscopy if younger.
The most common symptom among referred patients was rectal bleeding (69.1 per cent) followed by change in bowel habit (48.8 per cent) and abdominal pain (32.3 per cent). There was a significant trend (P < 0.001) for patients in the consultant-led to have more investigations, and more patients in this group had no investigations (P < 0.001). Despite this, the percentage of patients with colonic or other pathology diagnosed was the same in both groups, 63.6 per cent in the consultant-led group compared with 61.8 per cent in the open access group (P = 0.558). Likewise the percentage of patients with cancer or other significant pathology was similar in both groups (13.9 versus 15.4 per cent; P = 0.532). The mean(s.d.) time to diagnose cancer or other significant pathology was 55.1(39.2) days in the consultant-led group compared with 57.4(33.6) days in the open access group (P = 0.514). The cost per patient was almost pound 105 more for patients in the consultant-led group.
Patients referred by the general practitioner with large bowel symptoms should go directly to a properly managed and staffed open access large bowel investigation unit. This would enable most patients to have their investigations completed at one hospital attendance.
因大肠症状转诊的患者很常见且数量不断增加。目前，这些转诊患者大多在门诊接受评估，以确定检查的必要性和优先级。
在21个多月的时间里，对1131名由全科医生转诊的有大肠症状的患者进行了随机分组。由专科医生主导的小组中的患者由对结直肠疾病感兴趣的外科医生进行评估，而开放就诊组的患者如果年龄在55岁及以上则接受结肠镜检查，如果年龄较小则接受乙状结肠镜检查。
转诊患者中最常见的症状是直肠出血（69.1%），其次是排便习惯改变（48.8%）和腹痛（32.3%）。专科医生主导组的患者接受更多检查的趋势显著（P < 0.001），且该组中未接受检查的患者更多（P < 0.001）。尽管如此，两组中被诊断患有结肠或其他病变的患者百分比相同，专科医生主导组为63.6%，开放就诊组为61.8%（P = 0.558）。同样，两组中患有癌症或其他重大病变的患者百分比相似（13.9%对15.4%；P = 0.532）。专科医生主导组诊断癌症或其他重大病变的平均（标准差）时间为55.1（39.2）天，开放就诊组为57.4（33.6）天（P = 0.514）。专科医生主导组每位患者的费用比开放就诊组多近105英镑。
由全科医生转诊的有大肠症状的患者应直接前往管理完善、人员配备充足的开放就诊大肠检查科室。这将使大多数患者能够在一次就诊时完成检查。
