Tees Bowel Cancer Screening Centre, University Hospital of North Tees, Stockton-on-Tees, Cleveland, TS19 8PE, UK.
J Gastroenterol. 2011 Jan;46 Suppl 1:1-5. doi: 10.1007/s00535-010-0309-2. Epub 2010 Aug 27.
Patients with longstanding extensive colitis, both ulcerative colitis and Crohn's colitis, have an increased risk of developing colorectal cancer. Because of this risk, colonoscopic surveillance for neoplasia is recommended by most authorities. Although there has been no randomised controlled trial to demonstrate surveillance effectiveness, there are several retrospective comparative studies, which suggest that surveillance reduces colorectal cancer mortality. Over the past decade there have been a number of developments in our understanding of colitis cancer. We have discovered that the severity of colorectal inflammation is an important risk factor, in addition to other known risk factors such as the extent and duration of colitis, primary sclerosing cholangitis and a family history of colorectal cancer. Endoscopic techniques have also improved and evidence now demonstrates that pancolonic chromoendoscopy yields significantly more intraepithelial neoplasia than random biopsies. Endoscopic resection of well-circumscribed lesions is now also recognised as being an appropriate strategy, potentially reducing the number of patients requiring colectomy. It is hoped that such developments will further improve the effectiveness of colitis surveillance.
长期患有广泛结肠炎的患者，无论是溃疡性结肠炎还是克罗恩病结肠炎，都有增加罹患结直肠癌的风险。出于这种风险考虑，大多数权威机构建议对结直肠进行内镜监测以筛查肿瘤。尽管目前还没有随机对照试验来证明监测的有效性，但有一些回顾性比较研究表明，监测可以降低结直肠癌的死亡率。在过去十年中，我们对结肠炎癌症的认识有了一些进展。我们发现，除了其他已知的风险因素，如结肠炎的严重程度、范围和持续时间、原发性硬化性胆管炎以及结直肠癌的家族史之外，结直肠炎症的严重程度也是一个重要的风险因素。内镜技术也得到了改进，现在有证据表明，全结肠 chromoendoscopy 比随机活检能发现更多的上皮内瘤变。现在，内镜下切除边界清晰的病变也被认为是一种适当的治疗策略，可能会减少需要结肠切除术的患者数量。人们希望这些进展将进一步提高结肠炎监测的效果。
