CT 结肠成像用于结直肠癌筛查、诊断和术前分期的不良事件：一项日本全国性调查。
Adverse events during CT colonography for screening, diagnosis and preoperative staging of colorectal cancer: a Japanese national survey.
机构信息
Committee for Quality Assessment of Colorectal Cancer Screening, Japanese Society of Gastrointestinal Cancer Screening, Tokyo, Japan.
Gastrointestinal Advanced Imaging Academy, Tochigi, Japan.
出版信息
Eur Radiol. 2017 Dec;27(12):4970-4978. doi: 10.1007/s00330-017-4920-y. Epub 2017 Jul 3.
OBJECTIVES
To retrospectively evaluate the frequencies and magnitudes of adverse events associated with computed tomographic colonography (CTC) for screening, diagnosis and preoperative staging of colorectal cancer.
METHODS
A Japanese national survey on CTC was administered by use of an online survey tool in the form of a questionnaire. The questions covered mortality, colorectal perforation, vasovagal reaction, total number of examinations, and examination procedures. The survey data was collated and raw frequencies were determined. Fisher's exact test was used to determine differences in event rates between groups.
RESULTS
At 431 institutions, 147,439 CTC examinations were performed. No deaths were reported. Colorectal perforations occurred in 0.014% (21/147,439): 0.003% (1/29,823) in screening, 0.014% (13/91,007) in diagnosis and 0.028% (7/25,330) in preoperative staging. The perforation risk was significantly lower in screening than in preoperative staging CTC procedures (p = 0.028). Eighty-one per cent of perforation cases (17/21) did not require emergency surgery. Vasovagal reaction occurred in 0.081% (120/147,439): 0.111% (33/29,823) in screening, 0.088% (80/91,007) in diagnosis and 0.028% (7/25,330) in preoperative staging.
CONCLUSIONS
The risk of colorectal perforation and vasovagal reaction in CTC is low. The frequency of colorectal perforation associated with CTC is least in the screening group and greatest in the preoperative-staging group.
KEY POINTS
• The colorectal perforation rate during preoperative-staging CTC was 0.028 %. • The perforation rates for screening and diagnosis were 0.003 % and 0.014 %, respectively. • The perforation risk is significantly lower in screening than in preoperative staging. • Eighty-one per cent of perforation cases did not require emergency surgery. • Use of an automatic colon insufflator can reduce the risk of bowel perforation.
目的
回顾性评估计算机断层结肠成像（CTC）用于结直肠癌筛查、诊断和术前分期的不良事件发生频率和严重程度。
方法
采用在线问卷调查工具，对日本全国 CTC 调查进行管理。问题涵盖死亡率、结直肠穿孔、血管迷走神经反应、总检查次数和检查程序。汇总调查数据并确定原始频率。使用 Fisher 确切检验比较组间事件发生率的差异。
结果
在 431 家机构中，进行了 147439 例 CTC 检查。未报告死亡。发生结直肠穿孔 0.014%（21/147439）：筛查 0.003%（1/29823），诊断 0.014%（13/91007），术前分期 0.028%（7/25330）。筛查 CTC 程序的穿孔风险明显低于术前分期 CTC 程序（p=0.028）。81%的穿孔病例（17/21）无需急诊手术。血管迷走神经反应发生率为 0.081%（120/147439）：筛查 0.111%（33/29823），诊断 0.088%（80/91007），术前分期 0.028%（7/25330）。
结论
CTC 相关结直肠穿孔和血管迷走神经反应的风险较低。CTC 相关结直肠穿孔的频率在筛查组最低，在术前分期组最高。
关键要点
术前分期 CTC 时的结直肠穿孔率为 0.028%。
筛查和诊断的穿孔率分别为 0.003%和 0.014%。
筛查的穿孔风险明显低于术前分期。
81%的穿孔病例无需急诊手术。
使用自动结肠充气机可降低肠穿孔的风险。
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