Coccetta Marco, Migliaccio Carla, La Mura Francesco, Farinella Eriberto, Galanou Ioanna, Delmonaco Pamela, Spizzirri Alessandro, Napolitano Vincenzo, Cattorini Lorenzo, Milani Diego, Cirocchi Roberto, Sciannameo Francesco
Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
Ann Surg Innov Res. 2009 Nov 9;3:11. doi: 10.1186/1750-1164-3-11.
Between 5 and 10% of the patients undergoing a colonoscopy cannot have a complete procedure mainly due to stenosing neoplastic lesion of rectum or distal colon. Nevertheless the elective surgical treatment concerning the stenosis is to be performed after the pre-operative assessment of the colonic segments upstream the cancer. The aim of this study is to illustrate our experience with the Computed Tomographic Colonography (CTC) for the pre-operative assessment of the entire colon in the patients with stenosing colorectal cancers.
From January 2005 till March 2009, we observed and treated surgically 43 patients with stenosing colorectal neoplastic lesions. All patients did not tolerate the pre-operative colonoscopy. For this reason they underwent a pre-operative CTC in order to have a complete assessment of the entire colon. All patients underwent a follow-up colonoscopy 3 months after the surgical treatment. The CTC results were compared with both macroscopic examination of the specimen and the follow-up coloscopy.
The pre-operative CTC showed four synchronous lesions in four patients (9.3% of the cases). The macroscopic examination of the specimen revealed three small sessile polyps (3-4 mm in diameter) missed in the pre-operative assessment near the stenosing colorectal cancer. The follow-up colonoscopy showed four additional sessile polyps with a diameter between 3-11 mm in three patients. Our experience shows that CTC has a sensitivity of 83,7%.
In patients with stenosing colonic lesions, CTC allows to assess the entire colon pre-operatively avoiding the need of an intraoperative colonoscopy. More synchronous lesions are detected and treated at the time of the elective surgery for the stenosing cancer avoiding further surgery later on.
在接受结肠镜检查的患者中，5%至10%的患者无法完成整个检查过程，主要原因是直肠或结肠远端的狭窄性肿瘤病变。然而，关于狭窄的选择性手术治疗应在对癌症上游结肠段进行术前评估后进行。本研究的目的是阐述我们在计算机断层结肠成像（CTC）用于术前评估狭窄性结直肠癌患者整个结肠方面的经验。
从2005年1月至2009年3月，我们观察并手术治疗了43例患有狭窄性结直肠肿瘤病变的患者。所有患者均无法耐受术前结肠镜检查。因此，他们接受了术前CTC检查，以便对整个结肠进行全面评估。所有患者在手术治疗后3个月接受了随访结肠镜检查。将CTC结果与标本的宏观检查以及随访结肠镜检查结果进行了比较。
术前CTC在4例患者中显示出4个同步病变（占病例的9.3%）。标本的宏观检查发现了3个小的无蒂息肉（直径3 - 4毫米），在术前评估中遗漏于狭窄性结直肠癌附近。随访结肠镜检查在3例患者中又发现了4个直径在3 - 11毫米之间的无蒂息肉。我们的数据显示CTC的敏感性为83.7%。
在患有结肠狭窄病变的患者中，CTC能够在术前评估整个结肠，避免了术中结肠镜检查的需要。在对狭窄性癌症进行选择性手术时，能检测并治疗更多的同步病变，避免后续进一步手术。
