Fochios S E, Sommers S C, Korelitz B I
J Clin Gastroenterol. 1986 Jun;8(3 Pt 1):249-54. doi: 10.1097/00004836-198606000-00009.
Surveillance has become an established concept to find dysplasia as a premalignant lesion in ulcerative colitis. Since the advent of colonoscopy and the access of the entire colon to biopsy, utilization of the rigid sigmoidoscope and rectal biopsies has been markedly reduced. We have reviewed 940 rectal biopsies obtained from 360 patients with ulcerative colitis of various extent and duration to determine the yield of dysplasia and assess the value of this procedure. The rectal biopsies had been performed for a variety of reasons in the course of clinical management of ulcerative colitis in addition to surveillance. Dysplasia was found in 10.8% of the patients--higher than has been demonstrated by colonoscopy. In four of the 39 patients with dysplasia a carcinoma coexisted (2) or developed subsequently (2). In no instance did dysplasia serve to warrant the colectomy that disclosed the carcinoma, but earlier discovery of the dysplasia or more intense surveillance once it had been found might have led to earlier discovery of the carcinoma. The yield of dysplasia was greater in those with onset of ulcerative colitis in childhood. In more than half, including 71% of patients with onset in childhood, the dysplasia was found before they had the disease for 9 years. Surveillance, therefore, should begin earlier in young patients with ulcerative colitis. Sigmoidoscopic biopsies do not substitute for colonoscopic biopsies in a surveillance program. Nevertheless, the ease of obtaining rectal biopsies, the relatively large yield of dysplasia, and the need for frequent sigmoidoscopy in the clinical management of ulcerative colitis all warrant a high priority role for rectal biopsies to supplement that of colonoscopic biopsies.
监测已成为在溃疡性结肠炎中发现发育异常这一癌前病变的既定概念。自从结肠镜检查问世以及能够对整个结肠进行活检以来，硬式乙状结肠镜检查和直肠活检的应用已显著减少。我们回顾了从360例不同病程和范围的溃疡性结肠炎患者中获取的940份直肠活检样本，以确定发育异常的检出率并评估该检查方法的价值。除了监测之外，在溃疡性结肠炎的临床管理过程中，进行直肠活检还有各种其他原因。在10.8%的患者中发现了发育异常，这一比例高于结肠镜检查所显示的比例。在39例有发育异常的患者中，有4例同时存在癌（2例）或随后发生了癌（2例）。在任何情况下，发育异常都未能成为进行结肠切除术以发现癌的依据，但更早发现发育异常或在发现后进行更密切的监测可能会更早发现癌。溃疡性结肠炎在儿童期发病的患者中发育异常的检出率更高。超过半数的患者，包括71%在儿童期发病的患者，在患病9年之前就发现了发育异常。因此，对于年轻的溃疡性结肠炎患者，监测应更早开始。在监测计划中，乙状结肠镜活检不能替代结肠镜活检。然而，获取直肠活检样本的便捷性、发育异常相对较高的检出率以及在溃疡性结肠炎临床管理中对频繁进行乙状结肠镜检查的需求，都使得直肠活检在补充结肠镜活检方面具有高度优先的作用。
