Luchtefeld M A, Syverson D, Solfelt M, MacKeigan J M, Krystosek R, Waller J, Milsom J W
Ferguson Hospital, Grand Rapids, Michigan.
Dis Colon Rectum. 1991 Sep;34(9):763-8. doi: 10.1007/BF02051067.
Colonoscopy has been advocated by some investigators as the most appropriate means of screening asymptomatic patients with a positive family history of colorectal cancer. However, results of such screening have been widely disparate. The purpose of this study was to evaluate the yield of colonoscopy in a cohort of completely asymptomatic individuals with one or two first-degree relatives with a history of colorectal cancer and to compare this yield with that of colonoscopy in a group of patients with apparent anal bleeding. Patients with possible genetic disorders, such as familial polyposis, were excluded. A total of 160 asymptomatic patients and a comparison group of 137 patients with nonacute anorectal bleeding underwent colonoscopy. Colonoscopy was completed in 143 of the 160 study patients (89 percent) and in all of the comparison patients and did not result in any complications. Twenty-two adenomas were found in 17 study patients (10.6 percent); 16 of the 22 adenomas were less than 1 cm in size. In the comparison group, eight adenomas were identified (5.8 percent of patients). No cancers were identified. The difference in polyp frequency between groups was not significant. The relatively low yield of colorectal neoplasms discovered at colonoscopy in this study may in part be due to the small sample size or to the strict criteria used to define these asymptomatic patients but does not lend strong support to the notion that colonoscopy is an appropriate first step in screening the asymptomatic patient with one or two first-degree relatives with colon cancer.
一些研究者主张结肠镜检查是对有结直肠癌家族史的无症状患者进行筛查的最合适方法。然而，这种筛查的结果差异很大。本研究的目的是评估在一组有一或两个患结直肠癌的一级亲属的完全无症状个体中结肠镜检查的检出率，并将该检出率与一组有明显肛门出血的患者的结肠镜检查检出率进行比较。排除了患有可能的遗传疾病（如家族性息肉病）的患者。共有160例无症状患者和137例非急性肛肠出血患者组成的对照组接受了结肠镜检查。160例研究患者中有143例（89%）完成了结肠镜检查，对照组所有患者均完成了检查，且未出现任何并发症。17例研究患者（10.6%）发现了22个腺瘤；22个腺瘤中有16个直径小于1厘米。在对照组中，发现了8个腺瘤（占患者的5.8%）。未发现癌症。两组之间息肉发生率的差异不显著。本研究中结肠镜检查发现的结直肠肿瘤相对较低的检出率可能部分归因于样本量小或用于定义这些无症状患者的严格标准，但并不有力支持结肠镜检查是对有一或两个患结肠癌的一级亲属的无症状患者进行筛查的合适第一步这一观点。
