Stebbing J F, Nash A G
St Helier Hospital NHS Trust, Carshalton, Surrey.
Ann R Coll Surg Engl. 1995 Jan;77(1):21-3.
A retrospective study of 89 consecutive patients with carcinoma of the right colon presenting in a district general hospital over a 5-year period is reported. Of the patients, 74% were anaemic at the time of diagnosis and 27% of these had anaemia or a low mean corpuscular volume (MCV) for a significant time (mean 177 days, range 76-496 days) before developing symptoms. All doctors should be more vigilant towards anaemia or low MCV as presymptomatic indicators of possible colonic disease. Appropriate investigation is required in order to detect disease at an earlier stage and therefore influence survival. Significant delay in the diagnosis of symptomatic disease occurs before referral to hospital (mean 61 days vs 36 days, P < 0.05). Treatment delay is similar whether patients are referred to surgeons or physicians. The preoperative duration of symptoms for emergency admissions was significantly shorter than for elective admissions (mean 50 days vs 119 days, P < 0.05). The 30-day mortality was significantly higher for emergency admissions (20.7% vs 3.3%, P < 0.05). Earlier diagnosis of symptomatic disease may not reduce the proportion of emergency admissions (33%) or improve survival. Many tumours are at an advanced pathological stage (39% node positive) by the time symptoms develop.
本文报道了一项回顾性研究，该研究针对一家地区综合医院在5年期间收治的89例连续的右半结肠癌患者。这些患者中，74%在诊断时伴有贫血，其中27%的患者在出现症状前的较长时间内（平均177天，范围76 - 496天）存在贫血或低平均红细胞体积（MCV）。所有医生都应更加警惕贫血或低MCV，将其作为可能的结肠疾病的症状前指标。需要进行适当的检查以便在更早阶段发现疾病，从而影响生存率。有症状疾病在转诊至医院前诊断存在显著延迟（平均61天对36天，P < 0.05）。无论患者转诊给外科医生还是内科医生，治疗延迟情况相似。急诊入院患者术前症状持续时间明显短于择期入院患者（平均50天对119天，P < 0.05）。急诊入院患者的30天死亡率显著更高（20.7%对3.3%，P < 0.05）。有症状疾病的早期诊断可能不会降低急诊入院比例（33%）或提高生存率。许多肿瘤在出现症状时已处于晚期病理阶段（39%有淋巴结转移）。
