Cheung P S, Wong S K, Boey J, Lai C K
Department of Surgery, University of Hong Kong, Queen Mary Hospital.
Postgrad Med J. 1988 May;64(751):364-8. doi: 10.1136/pgmj.64.751.364.
In order to determine the frequency of tumours in patients presenting with frank rectal bleeding, a prospective study was carried out in 337 patients over the age of 40 attending our Proctology Clinic. After making a clinical diagnosis, flexible sigmoidoscopy followed by barium enema was performed. Excluding 7 digitally palpable rectal cancers, there were 30 cancers (9.1%), 34 polyps (10.3%), 7 proctocolitis (2.1%) and 25 diverticula (7.6%) detected, giving a total diagnostic yield of 29.1%. A clinical diagnosis of bleeding sources other than haemorrhoids was made in 80% of the cancers. Flexible sigmoidoscopy detected 93.3% of the cancers and 88.2% of the polyps. Barium enema diagnosed the remaining cancers and polyps but there was a false-positive rate of 3.8%. From our results, we conclude that patients with frank rectal bleeding should be screened routinely for left-colon cancer irrespective of the clinical diagnosis. The flexible sigmoidoscope is a quick and useful tool. However, barium enema should be recommended to individuals with strong clinical suspicion of rectal bleeding other than haemorrhoids.
为了确定出现明显直肠出血的患者中肿瘤的发生率，我们对337名40岁以上到我院直肠科门诊就诊的患者进行了一项前瞻性研究。做出临床诊断后，先进行乙状结肠镜检查，然后进行钡剂灌肠。排除7例指诊可触及的直肠癌后，共检测到30例癌症（9.1%）、34例息肉（10.3%）、7例直肠结肠炎（2.1%）和25例憩室（7.6%），总诊断率为29.1%。80%的癌症患者做出了除痔疮外其他出血来源的临床诊断。乙状结肠镜检查发现了93.3%的癌症和88.2%的息肉。钡剂灌肠诊断出了其余的癌症和息肉，但假阳性率为3.8%。根据我们的研究结果，我们得出结论，无论临床诊断如何，出现明显直肠出血的患者都应常规筛查左半结肠癌。乙状结肠镜是一种快速且有用的工具。然而，对于临床高度怀疑除痔疮外直肠出血的个体，应推荐进行钡剂灌肠。
