Meyer C T, McBride W, Goldblatt R S, Borak J, Marignani P, Black H R, McCallum R W
Yale J Biol Med. 1980 Sep-Oct;53(5):345-52.
The purpose of this study was to evaluate the diagnostic yield of flexible sigmoidoscopy when performed as a routine procedure in asymptomatic patients over the age of 40 being referred for a complete physical examination. The preliminary results of this ongoing program are presented together with the diagnostic yield in 408 patients with symptoms and signs suggestive of colorectal disease who were of similar age (56.6 vs. 56.5 years) and sex distribution (79 percent male) to the asymptomatic population, and who underwent flexible sigmoidoscopy as an indicated part of their evaluation. In the 122 asymptomatic patients, the mean distance examined by the procedure was 50.8 cm with the instrument being advanced beyond the optimal rigid sigmoidoscopy distance of 20 cm in 100 percent of patients. Adenomatous and hyperplastic polyps were identified in 16 patients, 13.1 percent, in the asymptomatic group, a similar percentage to the symptomatic population, 15.4 percent. Adenomatous polyps were diagnosed in 7.4 percent of the asymptomatic subjects and 9.1 percent of the symptomatic group. Colonic cancer was diagnosed in 0.8 percent of asymptomatic patients vs. 3.2 percent of the symptomatic group (p < 0.05). Seventy-seven percent of the neoplastic polyps detected in the asymptomatic patients and 60 percent in the symptomatic group were beyond 20 cm from the anus. Diverticulosis was diagnosed in a similar percentage of patients, 13.1 percent in the asymptomatic and 10.0 percent in the symptomatic group. No complications were encountered and the procedure was well tolerated without analgesia. It is concluded that: (1) in an asymptomatic population over the age of 40, flexible sigmoidoscopy, as a routine examination, results in a diagnostic yield not possible with rigid proctosigmoidoscopy and which approaches that observed in a symptomatic population of similar age; (2) for the internist trained in this procedure, flexible sigmoidoscopy has a future role in the detection of colorectal lesions and as an interval screening examination for premalignant lesions and colorectal cancer in asymptomatic and symptomatic patients.
本研究的目的是评估在40岁以上因全面体检而转诊的无症状患者中，将乙状结肠镜检查作为常规程序时的诊断率。本正在进行的项目的初步结果，以及408例有结肠直肠疾病症状和体征、年龄（56.6岁对56.5岁）和性别分布（79%为男性）与无症状人群相似的患者的诊断率一并呈现，这些有症状的患者作为评估的一部分接受了乙状结肠镜检查。在122例无症状患者中，该检查平均检查距离为50.8 cm，100%的患者检查器械推进超过了20 cm的最佳硬式乙状结肠镜检查距离。无症状组有16例患者（13.1%）发现腺瘤性和增生性息肉，与有症状人群的比例相似，为15.4%。无症状受试者中7.4%诊断为腺瘤性息肉，有症状组为9.1%。无症状患者中0.8%诊断为结肠癌，有症状组为3.2%（p<0.05）。无症状患者中检测到的肿瘤性息肉77%位于距肛门20 cm以外，有症状组为60%。憩室病在两组患者中的诊断比例相似，无症状组为13.1%，有症状组为10.0%。未发生并发症，该检查在未使用镇痛的情况下耐受性良好。结论如下：（1）在40岁以上的无症状人群中，乙状结肠镜检查作为常规检查，其诊断率是硬式直肠乙状结肠镜检查无法达到的，且接近在相似年龄有症状人群中观察到的诊断率；（2）对于接受过该检查培训的内科医生而言，乙状结肠镜检查在检测结肠直肠病变以及作为无症状和有症状患者的癌前病变及结肠癌的定期筛查检查方面具有未来作用。
