Tripp M R, Morgan T R, Sampliner R E, Kogan F J, Protell R L, Earnest D L
Cancer. 1987 Oct 1;60(7):1599-603. doi: 10.1002/1097-0142(19871001)60:7<1599::aid-cncr2820600730>3.0.co;2-i.
The distribution of synchronous neoplasms was retrospectively analyzed in 220 patients undergoing initial colonoscopic evaluation for colorectal neoplasms. In 159 of the 220 patients, an index neoplasm was present in the rectosigmoid region. Of these 159 patients, 32 had an index rectosigmoid adenoma less than 5 mm in diameter (diminutive), 105 had an index rectosigmoid adenoma greater than or equal to 5 mm in diameter and 22 had an index rectosigmoid adenocarcinoma. Among these patients with different index neoplasms the frequency of synchronous neoplasms was 34%, 53%, and 73%, respectively. The synchronous neoplasm was an adenoma greater than or equal to 5 mm in diameter in 13%, 40%, and 64%, respectively. The synchronous neoplasm was a carcinoma in 0%, 7%, and 5%, respectively. Two or more synchronous neoplasms occurred in 9%, 34%, and 41% of the index neoplasm groups, respectively. Finally, symptoms providing an indication for colonoscopy were present in 31%, 75%, and 86%, respectively. It is concluded that patients with diminutive index adenomas had fewer and smaller synchronous neoplasms (P less than 0.025) than patients with larger adenomas or invasive carcinoma as the index lesion. Thus, total colonoscopy does not appear to be necessary in asymptomatic patients with only diminutive adenomas found at flexible sigmoidoscopy.
对220例因结直肠肿瘤接受初次结肠镜检查的患者同步肿瘤的分布情况进行了回顾性分析。在这220例患者中，159例的索引肿瘤位于直肠乙状结肠区域。在这159例患者中，32例的索引直肠乙状结肠腺瘤直径小于5mm（微小腺瘤），105例的索引直肠乙状结肠腺瘤直径大于或等于5mm，22例的索引直肠乙状结肠腺癌。在这些具有不同索引肿瘤的患者中，同步肿瘤的发生率分别为34%、53%和73%。同步肿瘤为直径大于或等于5mm的腺瘤的比例分别为13%、40%和64%。同步肿瘤为癌的比例分别为0%、7%和5%。两种或更多种同步肿瘤分别在索引肿瘤组的9%、34%和41%的患者中出现。最后，提示进行结肠镜检查的症状分别出现在31%、75%和86%的患者中。得出的结论是，与以较大腺瘤或浸润性癌作为索引病变的患者相比，微小索引腺瘤患者的同步肿瘤数量更少且更小（P<0.025）。因此，对于在乙状结肠镜检查中仅发现微小腺瘤的无症状患者，似乎没有必要进行全结肠镜检查。
