Department of Surgery, The George Washington University Medical Center, 2150 Pennsylvania Ave. NW, Suite 6B, Washington, DC 20037, USA.
Surg Endosc. 2010 Oct;24(10):2502-5. doi: 10.1007/s00464-010-0993-2. Epub 2010 Mar 24.
The objective of this study was to evaluate the accuracy of preoperative colonoscopic localization of colonic lesions. Localization of the colonic lesion plays a key role in determining the type of operation a patient may require. Inaccurate localization may result in removal of the wrong segment of colon and/or a change in the operation performed.
A retrospective review of patients who had a colon resection by a single surgeon after preoperative colonoscopic localization between 1991 and 2008 was performed. A comparison of the preoperative colonoscopic localization and the final intraoperative localization was made. Clinical and demographic information was gathered to determine accuracy rates and identify predictive factors.
Three hundred and seventy-four patients were included and 184 (49%) were male. The mean age was 61.6 years. Three hundred and sixty-two (97%) patients underwent colon resection for cancer. Fifteen (4%) patients had nonconcordant colonoscopic and intraoperative findings. Fourteen of the 15 (93%) were resected for cancer and 1 for inflammatory bowel disease (IBD). Seven (47%) lesions were inaccurately localized in the sigmoid colon, four (27%) in the descending colon, two (13%) in the ascending colon, one (7%) in the rectum, and one (7%) lesion was not visualized preoperatively. Eleven of the 15 (73%) patients with nonconcordant localization had a modification of their planned procedure. Ten patients underwent a different segmental colectomy and one patient had an extended resection.
Preoperative colonoscopic localization of colorectal lesions was reasonably accurate (96%) in this large series. The majority of inaccurately identified lesions occurred in the sigmoid and descending colon. Erroneous localization, even though not common, can result in significant changes in the intraoperative plan and the ultimate outcome. Therefore, every effort should be made to localize the lesion before surgery, especially when thought to be in the left or sigmoid colon, to reduce the need for intraoperative localization efforts, the need for an intraoperative change in procedure, and the risk of a surprise for the patient after surgery.
本研究旨在评估术前结肠镜定位结直肠病变的准确性。病变的定位在确定患者可能需要的手术类型方面起着关键作用。不准确的定位可能导致切除错误的结肠段和/或改变手术方式。
对 1991 年至 2008 年间由一位外科医生进行术前结肠镜定位并随后进行结肠切除术的患者进行回顾性研究。比较了术前结肠镜定位和最终术中定位。收集临床和人口统计学信息以确定准确率并确定预测因素。
共纳入 374 例患者，其中 184 例（49%）为男性。平均年龄为 61.6 岁。362 例（97%）患者因癌症行结肠切除术。15 例（4%）患者结肠镜和术中发现不一致。14 例（93%）为癌症切除，1 例为炎症性肠病（IBD）切除。7 例（47%）病变定位不准确，位于乙状结肠，4 例（27%）位于降结肠，2 例（13%）位于升结肠，1 例（7%）位于直肠，1 例（7%）病变术前未显示。15 例定位不一致的患者中有 11 例手术方案发生改变。10 例患者行不同节段结肠切除术，1 例患者行扩大切除术。
在本大型系列研究中，术前结肠镜定位结直肠病变的准确率相当高（96%）。大多数定位不准确的病变发生在乙状结肠和降结肠。尽管并不常见，但错误的定位会导致术中计划和最终结果发生重大变化。因此，在手术前应尽最大努力定位病变，尤其是当病变被认为位于左侧或乙状结肠时，以减少术中定位的需要、术中改变手术方式的需要以及患者术后的意外风险。
