Barillari P, Ramacciato G, De Angelis R, Gozzo P, Indinnimeo M, Valabrega S, Aurello P, Fegiz G
First Department of Surgery, University of Rome, Italy.
Acta Chir Scand. 1990 Feb;156(2):163-6.
Colonoscopy and air-contrast barium enema performed preoperatively in 389 patients with colorectal cancer revealed synchronous cancer in 4% and polyp in 14%. Nine of the 16 synchronous cancers were located in other surgical segments than the index cancer, and six of the nine were in stage A or B1. Of the 54 synchronous polyps, 28 were located in such other segments. Half of the synchronous cancers and almost half of the synchronous polyps were missed at double-contrast barium enema. All synchronous cancers and three-fourths of the synchronous polyps were detected at colonoscopy. No patient with preoperative colonoscopy presented with metachronous cancer within 3 years from surgery, and only two were subsequently found to have adenocarcinoma arising from an adenomatous polyp. Endoscopic polypectomy was performed in 21 cases during follow-up. Extensive use of preoperative colonoscopy is recommended in the evaluation of colorectal cancer, in order to promote detection of synchronous tumors, reduce the incidence of 'early metachronous' cancer and avoid malignant degeneration of adenomatous polyp.
对389例结直肠癌患者术前进行的结肠镜检查和气钡双重对比灌肠显示，4%的患者存在同时性癌，14%的患者存在息肉。16例同时性癌中有9例位于与原发癌不同的手术节段，其中9例中的6例处于A期或B1期。在54例同时性息肉中，28例位于其他节段。双重对比钡灌肠漏诊了一半的同时性癌和几乎一半的同时性息肉。结肠镜检查发现了所有的同时性癌和四分之三的同时性息肉。术前接受结肠镜检查的患者在术后3年内均未出现异时性癌，仅有2例患者随后被发现腺瘤性息肉发生腺癌。随访期间对21例患者实施了内镜下息肉切除术。建议在结直肠癌评估中广泛应用术前结肠镜检查，以促进同时性肿瘤的检出，降低“早期异时性”癌的发生率，并避免腺瘤性息肉恶变。
