Weitzel C, Holstege A
Klinik und Poliklinik für Innere Medizin, Klinikum der Universität Regensburg.
Praxis (Bern 1994). 1997 Sep 24;86(39):1520-5.
The efficacy of standardized follow-up examinations after surgery for colorectal carcinoma has been repeatedly questioned. Although many studies have assessed the value of different diagnostic tools none of these procedures proved to have a predictive value high enough to accurately predict the recurrence of disease and to justify its regular use in these patients. Even a combined diagnostic approach provided a benefit only for a minority of these patients (3.5 to 4.5%). Considering the physical and psychological strain imposed by this approach risk-adapted follow-up schemes are urgently needed. Prognostic parameters indicating the individual risk for disease recurrence can be deduced from increasing CEA values as well as from classification and grading of the primary tumor. Colonoscopy is an effective procedure for early detection of intraluminal relapse or metachronous tumors with potential impact on survival of the patient. An abdominal ultrasound study appears to be the method of choice for detection of metastasis of the liver due to its high sensitivity and low invasiveness. Other imaging procedures are not indicated in routine follow-up for colorectal carcinoma. It remains to be demonstrated whether molecular biology or new scintigraphic techniques will be helpful in follow-up examinations of patients with colorectal carcinomas.
结直肠癌手术后标准化随访检查的疗效一直备受质疑。尽管许多研究评估了不同诊断工具的价值，但这些检查方法均未被证明具有足够高的预测价值，无法准确预测疾病复发，也无法证明在这些患者中常规使用的合理性。即使采用联合诊断方法，也仅对少数患者（3.5%至4.5%）有益。考虑到这种方法带来的身体和心理负担，迫切需要根据风险调整随访方案。可从癌胚抗原（CEA）值升高以及原发肿瘤的分类和分级中推断出表明个体疾病复发风险的预后参数。结肠镜检查是早期发现腔内复发或异时性肿瘤的有效方法，可能对患者生存产生影响。腹部超声检查因其高灵敏度和低侵入性，似乎是检测肝转移的首选方法。其他成像检查在结直肠癌的常规随访中并无必要。分子生物学或新的闪烁显像技术是否有助于结直肠癌患者的随访检查仍有待证实。
