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老年患者的结肠镜检查：一项200例病例的研究。

Colonoscopy in the elderly: a study of 200 cases.

作者信息

Chatrenet P, Friocourt P, Ramain J P, Cherrier M, Maillard J B

机构信息

Centre Hospitalier, Blois, France.

出版信息

Eur J Med. 1993 Aug-Sep;2(7):411-3.

PMID:8258030

Abstract

OBJECTIVES

To evaluate tolerance and diagnostic yield of colonoscopy in elderly patients.

METHODS

We studied retrospectively 200 consecutive colonoscopies performed in patients older than 80 years (mean age: 83.5 +/- 3.1). We analyzed the following factors: indication, type and tolerance of the preparation, analgesia, tolerance of the procedure, information provided by the examination and therapeutic consequences.

RESULTS

The indications were: anaemia in 81 cases, change in bowel habits in 58 cases, rectal bleeding in 26 cases and others in 35 cases. Preparation (4.2 +/- 1.3 L Polyethylene-glycol) was good 150 times (75%), moderate 27 times and poor 23 times. It was tolerated well 122 times (61%) and poorly 78 times (39%). Sixty-six colonoscopies were performed without any analgesia, diazanalgesia was used in 108 cases, general anesthesia in 8 and diazepam and/or antispasmodics in 18. Tolerance of colonoscopy was good in 140 cases (70%), moderate in 37 cases and poor in 23 cases. Tolerance was better with analgesia than without (p < 0.001). The caecum was reached in 167 cases (83.5%). Colonoscopy was normal in 68 cases (34%). The lesions discovered were: 40 polyps larger than 10 mm, 41 diverticulosis, 29 cancers, 7 ischaemic colitis, 5 angiodysplasias, 5 sigmoiditis, 3 villous adenomas, 1 Bothriocephalus and 1 thermometric ulceration. A lesion responsible for the symptoms was diagnosed in 80 cases (40%). Diagnostic yield was better when indication was anaemia (52%) than change in bowel habits (24%) (p < 0.001). The lesions were treated endoscopically in 41 cases (38 polypectomies, 3 electrocoagulations) and surgically in 22 cases. Colonoscopy as well as its preparation were well tolerated in 93 cases (46.5%).

CONCLUSION

In a selected elderly population, colonoscopy was better tolerated with analgesia; large bowel preparation was often difficult. The diagnostic yield was relatively good. A multicentric prospective study is underway in order to determine the predictive criterias allowing an improvement of colonoscopic yield in the elderly.

摘要

目的

评估老年患者结肠镜检查的耐受性及诊断率。

方法

我们回顾性研究了连续200例年龄大于80岁（平均年龄：83.5±3.1岁）患者的结肠镜检查情况。我们分析了以下因素：适应证、肠道准备的类型及耐受性、镇痛方式、操作耐受性、检查提供的信息及治疗结果。

结果

适应证包括：81例贫血，58例排便习惯改变，26例直肠出血，35例其他情况。肠道准备（4.2±1.3L聚乙二醇）良好150次（75%），中等27次，差23次。耐受性良好122次（61%），差78次（39%）。66例结肠镜检查未使用任何镇痛措施，108例使用地西泮镇痛，8例使用全身麻醉，18例使用地西泮和/或解痉药。结肠镜检查耐受性良好140例（70%），中等37例，差23例。使用镇痛措施的耐受性优于未使用者（p<0.001）。167例（83.5%）到达盲肠。68例（34%）结肠镜检查正常。发现的病变有：40个直径大于10mm的息肉，41例憩室病，29例癌症，7例缺血性结肠炎，5例血管发育异常，5例乙状结肠炎，3例绒毛状腺瘤，1例裂头绦虫感染，1例温度性溃疡。80例（40%）诊断出导致症状的病变。当适应证为贫血时诊断率（52%）高于排便习惯改变时（24%）（p<0.001）。41例病变进行了内镜治疗（38例息肉切除术，3例电凝术），22例进行了手术治疗。93例（46.5%）对结肠镜检查及其准备耐受性良好。