Matheny R, Symmonds R E
Surg Clin North Am. 1986 Aug;66(4):801-6. doi: 10.1016/s0039-6109(16)43991-5.
The tendency for development of cancer in patients with ulcerative colitis is well documented. Each physician must take into account the clinical presentation of the patient and the known risk factors and must adapt follow-up and consultation to the patient and family accordingly. Presently, after a 5- to 7-year history of ulcerative colitis, it is reasonable to document mucosal changes with air-contrast barium enema examination and laboratory assessment with carcinoembryonic antigen levels being obtained. If the extent of disease is more limited to the distal colon, then the surveillance should be modified accordingly because the relative risk is reduced. In the future, the addition of histochemical and immunohistologic analysis of mucosal biopsies will result in better criteria for patient selection for surgical intervention. Because of the delay in recognition of a cancerous lesion in patients with ulcerative colitis, a total proctocolectomy is recommended by some after the first decade of disease. Most prefer, however, to continue surveillance of some type. During surveillance, if moderate or severe dysplasia is found, a proctocolectomy should be performed. This mode of surveillance and treatment of patients at risk for developing colonic carcinoma subsequent to ulcerative colitis remains an evolving process. There will be further changes in management following better classification of the neoplastic changes and the discovery of the etiology of the disease process itself.
溃疡性结肠炎患者患癌的倾向已有充分记录。每位医生都必须考虑患者的临床表现和已知的风险因素，并据此调整对患者及其家属的随访和会诊。目前，在溃疡性结肠炎病史达5至7年后，通过气钡双重造影灌肠检查记录黏膜变化并检测癌胚抗原水平进行实验室评估是合理的。如果病变范围更局限于结肠远端，那么监测应相应调整，因为相对风险会降低。未来，对黏膜活检进行组织化学和免疫组织学分析将为手术干预的患者选择提供更好的标准。由于溃疡性结肠炎患者癌性病变的识别存在延迟，一些人建议在患病十年后进行全直肠结肠切除术。然而，大多数人更倾向于继续某种形式的监测。在监测过程中，如果发现中度或重度发育异常，应进行全直肠结肠切除术。对溃疡性结肠炎后有患结肠癌风险的患者进行这种监测和治疗的模式仍在不断发展。随着肿瘤性变化的更好分类以及疾病过程本身病因的发现，管理还会有进一步的变化。
