Department of Surgery, St. John's Queens Hospital, Queens, New York, NY, USA.
World J Surg. 2010 Jul;34(7):1587-91. doi: 10.1007/s00268-009-0358-y.
Colonoscopy findings compared with findings at time of surgery have a discrepancy rate of 3-21%. The objective of our study was to investigate this discrepancy and provide potential resolutions.
In this retrospective study, we identified 400 patients who underwent colonoscopy followed by colon resection at our community hospitals in 1999-2006. Discrepancies between colonoscopy and intraoperative findings were noted. Each discrepancy was classified as major if the surgical procedure had to be altered, the lesion was missed, an unnecessary segment was removed, or the incision was extended. A discrepancy was classified as minor if there was no alteration in planned surgery.
Of the 400 cases, 160 (40%) were located in the right colon, 13 (3%) were in the transverse colon, 185 (46%) were in the left colon, and 42 (11%) were in the rectum. A total of 48 (12%) discrepancies between colonoscopy and intraoperative findings were identified: 26 (54%) were major and 22 (46%) were minor. Thirteen (27%) were in the proximal colon (3 major and 10 minor discrepancies), 3 (6.3%) were in the transverse colon (all major), 22 (46%) were in the distal colon (17 major and 5 minor), and 10 (21%) were in the rectum (3 major, 7 minor). Major discrepancies were significantly higher in the left colon (17 of the 185 left-sided lesions; 9.1%) than in the right colon (3/160; 1.9%; P = 0.045).
In our study, colonoscopy has an error rate of 12% when used to localize tumors; more than half of these patients require significant unanticipated changes in their surgery. The discrepancies are significantly higher in left side of colon.
结肠镜检查结果与手术时的发现之间存在 3-21%的差异率。我们研究的目的是调查这种差异并提供潜在的解决方案。
在这项回顾性研究中，我们确定了 1999 年至 2006 年在我们的社区医院接受结肠镜检查后行结肠切除术的 400 名患者。记录结肠镜检查与术中发现之间的差异。如果手术程序必须改变、病变被遗漏、不必要的节段被切除或切口延长，则将每个差异归类为主要差异。如果计划手术没有改变，则将差异归类为次要差异。
400 例中，160 例（40%）位于右结肠，13 例（3%）位于横结肠，185 例（46%）位于左结肠，42 例（11%）位于直肠。结肠镜检查与术中发现之间共有 48 处差异：26 处（54%）为主要差异，22 处（46%）为次要差异。13 例（27%）位于近端结肠（3 例主要和 10 例次要差异），3 例（6.3%）位于横结肠（均为主要差异），22 例（46%）位于远端结肠（17 例主要和 5 例次要差异），10 例（21%）位于直肠（3 例主要，7 例次要）。左结肠的主要差异明显高于右结肠（185 例左侧病变中有 17 例；9.1%比 160 例中的 3 例；1.9%；P = 0.045）。
在我们的研究中，结肠镜检查定位肿瘤的准确率为 12%；超过一半的患者需要对手术进行重大的意外改变。差异在结肠左侧更为显著。
