Goulston K J, Cook I, Dent O F
Lancet. 1986 Aug 2;2(8501):261-5. doi: 10.1016/s0140-6736(86)92081-7.
Overt bleeding from the anus is a common symptom of colorectal cancer but most frequently arises from a benign anal source. The aim of this study was to determine how successfully general practitioners and gastroenterologists could differentiate anal from colorectal sources of bleeding before full colonic investigation. 145 consecutive patients aged 40 years and over who had presented to a GP with rectal bleeding of less than 6 months' duration were referred to a specialist for total colonic investigation. The source of bleeding was diagnosed as colorectal cancer in 15 patients (7 stage A, 3 stage B) and polyps in 11. Of 63 patients in whom GPs predicted an anal source of bleeding only, 11 were ultimately found to be bleeding from a colonic or rectal source. The gastroenterologists (after rigid sigmoidoscopy) predicted an anal source of bleeding in 97, in 5 of whom the source was ultimately found to be colorectal. All patients aged over 40 who present with recent rectal bleeding should be referred for full colonic investigation.
肛门明显出血是结直肠癌的常见症状，但最常见的是来自良性肛门来源。本研究的目的是确定全科医生和胃肠病学家在进行全结肠检查之前，能够多成功地区分肛门出血和结肠出血的来源。145例年龄40岁及以上、因直肠出血就诊于全科医生且病程少于6个月的连续患者被转诊至专科医生处进行全结肠检查。15例患者（7例A期，3例B期）出血源被诊断为结直肠癌，11例为息肉。在63例全科医生仅预测为肛门出血源的患者中，最终发现11例是结肠或直肠出血源。胃肠病学家（在硬式乙状结肠镜检查后）预测97例为肛门出血源，其中5例最终发现出血源是结肠。所有40岁以上近期出现直肠出血的患者都应转诊进行全结肠检查。
