低风险和中等风险结直肠癌患者便血的结肠镜评估：一项前瞻性研究。
Colonoscopic evaluation of hematochezia in low and average risk patients for colorectal cancer: a prospective study.
作者信息
Carlo Puglisi, Paolo Russo-Francesco, Carmelo Barbera, Salvatore Incarbone, Giuseppe Aprile, Giacomo Bonanno, Antonio Russo
机构信息
Azienda Ospedaliero Universitaria Policlinico, Via S. Sofia N 78, Catania 95100, Italy.
出版信息
World J Gastroenterol. 2006 Dec 7;12(45):7304-8. doi: 10.3748/wjg.v12.i45.7304.
AIM
To relate the endoscopic findings in patients with hematochezia with regard to age in "low and average risk" for colorectal cancer (CRC) and to localize significant lesions in order to identify patients who need sigmoidoscopy or total colonoscopy.
METHODS
This prospective study was performed in an open access GI endoscopy unit. Out of 4322 consecutive patients undergoing colonoscopy, 918 reported hematochezia. The final study group comprized 180 patients aged below 45 and 237 over 45. Main exclusion criteria were a 1st-degree family history of colorectal carcinoma, patients reporting blood mixed with stools and/or progressive colonic symptoms, or patients who had undergone colon surgery for neoplastic lesions.
RESULTS
Total colonoscopy could be performed in 96% of patients. Abnormal findings were observed in 34.3% of the younger and in 65.7% of the older ones. Findings were the presence of polyps in the distal colon (n = 2) and IBD in the proximal colon (n = 29) in the group of the younger patients, and polyps (n = 15), IBD (n = 13), and carcinoma (n = 6, 4 of the lesions were located proximal to the splenic flexure) in the elderly. Our findings suggest that the diagnostic potential of total colonoscopy in patients younger than 45 referring scant hematochezia, is not mandatory. By exploring only the distal tract of the colon we have misdiagnosed two cases of IBD located in the ascending colon. In this group of patients additional risk factors must be identified before performing a total colonoscopy. Regarding the patients older than 45 yr, the exploration of the distal colon would have led to our overlooking a carcinoma, two neoplastic polyps and one IBD located in the proximal colon.
CONCLUSION
Young patients with scant hematochezia but without risk factors for neoplasia do not need a total colonoscopy, whereas is mandatory performing a total colonoscopy in older patients even in the presence of anal pathology.
目的
探讨便血患者的内镜检查结果与年龄的关系，这些患者处于结直肠癌（CRC）“低风险和中等风险”，并定位重要病变，以确定需要进行乙状结肠镜检查或全结肠镜检查的患者。
方法
这项前瞻性研究在一个开放获取的胃肠内镜科室进行。在连续接受结肠镜检查的4322例患者中，918例报告有便血。最终研究组包括180例年龄在45岁以下和237例年龄在45岁以上的患者。主要排除标准为结直肠癌一级家族史、报告大便带血和/或进行性结肠症状的患者，或因肿瘤性病变接受过结肠手术的患者。
结果
96%的患者能够进行全结肠镜检查。在较年轻患者中，34.3%观察到异常结果；在较年长患者中，65.7%观察到异常结果。较年轻患者组的发现为远端结肠有息肉（n = 2）和近端结肠有炎症性肠病（IBD，n = 29），而老年患者组的发现为息肉（n = 15）、IBD（n = 13）和癌（n = 6，其中4个病变位于脾曲近端）。我们的研究结果表明，对于便血较少的45岁以下患者，全结肠镜检查的诊断潜力并非必需。仅探查结肠远端，我们误诊了2例位于升结肠的IBD病例。在这组患者中，进行全结肠镜检查前必须识别其他风险因素。对于45岁以上的患者，探查远端结肠会导致我们漏诊1例癌、2例肿瘤性息肉和1例位于近端结肠的IBD。
结论
便血较少但无肿瘤形成风险因素的年轻患者不需要进行全结肠镜检查，而老年患者即使存在肛门病变，进行全结肠镜检查也是必需的。
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