溃疡性结肠炎和原发性硬化性胆管炎患者的结直肠肿瘤形成

Colorectal neoplasia in patients with ulcerative colitis and primary sclerosing cholangitis.

作者信息

Gurbuz A K, Giardiello F M, Bayless T M

机构信息

Meyerhoff Digestive Disease and Inflammatory Bowel Disease Center, Department of Medicine, Johns Hopkins University School of Medicine and Hospital, Baltimore, Maryland 21287-4461.

出版信息

Dis Colon Rectum. 1995 Jan;38(1):37-41. doi: 10.1007/BF02053855.

DOI:10.1007/BF02053855

PMID:7813342

Abstract

PURPOSE

Most patients with primary sclerosing cholangitis also have ulcerative colitis. It has been suggested that in the presence of primary sclerosing cholangitis the risk of colorectal dysplasia and carcinoma is greater than in patients with ulcerative colitis alone.

METHODS

In a retrospective study, we evaluated the possibility of colorectal cancer or dysplasia in 35 consecutive patients with primary sclerosing cholangitis and ulcerative colitis seen at The Johns Hopkins Hospital between 1979 and 1991.

RESULTS

Thirteen of the 35 patients (37 percent) with ulcerative colitis and primary sclerosing cholangitis had colorectal neoplasia (5 with adenocarcinoma and 8 with dysplasia). In the 27 patients undergoing colonoscopic biopsy surveillance, the cumulative incidence at 28 years of colorectal cancer was 18.5 percent and for colorectal dysplasia it was 29.6 percent. The high incidence of colorectal cancer was less than the rate of colorectal cancer in patients with extensive colitis of childhood onset without primary sclerosing cholangitis (35 percent), but the rate of colorectal cancer and dysplasia (48.1 percent) is similar to the highest rates of cancer noted in the comparison group. Because patients had subtle, quiescent colitis, a short time from diagnosis of ulcerative colitis to diagnosis of colorectal neoplasia was noted (mean, 12.2 +/- 9 years; less than 8 years in 5/13 (38.5 percent) patients).

CONCLUSION

Ulcerative colitis patients with primary sclerosing cholangitis appear to have a high frequency of colorectal cancer but a rate lower than expected in patients with extensive quiescent ulcerative colitis of childhood onset alone. However, exact conclusions are complicated by the high incidence of colorectal dysplasia found, which portends malignant transformation. Because of the subtle nature of colitis, the diagnosis of ulcerative colitis is often delayed, and surveillance programs should start as soon as ulcerative colitis is diagnosed.

摘要

目的

大多数原发性硬化性胆管炎患者也患有溃疡性结肠炎。有人提出，在原发性硬化性胆管炎存在的情况下，结直肠发育异常和癌的风险高于仅患有溃疡性结肠炎的患者。

方法

在一项回顾性研究中，我们评估了1979年至1991年间在约翰霍普金斯医院就诊的35例连续性原发性硬化性胆管炎合并溃疡性结肠炎患者发生结直肠癌或发育异常的可能性。

结果

35例溃疡性结肠炎合并原发性硬化性胆管炎患者中有13例（37%）发生了结直肠肿瘤（5例腺癌，8例发育异常）。在27例行结肠镜活检监测的患者中，28年时结直肠癌的累积发病率为18.5%，结直肠发育异常的累积发病率为29.6%。结直肠癌的高发病率低于儿童期起病的广泛性结肠炎且无原发性硬化性胆管炎患者的结直肠癌发病率（35%），但结直肠癌和发育异常的发病率（48.1%）与对照组中所观察到的最高癌症发病率相似。由于患者的结肠炎症状不明显且处于静止期，从溃疡性结肠炎诊断到结直肠肿瘤诊断的时间较短（平均12.2±9年；13例中有5例（38.5%）患者不到8年）。