Lawitz E, Kadakia S C
United States Army Medical Corps, Gastroenterology Service, Brooke Army Medical Center, Fort Sam Houston, Texas 78234-6200, USA.
Gastrointest Endosc. 1998 May;47(5):350-3. doi: 10.1016/s0016-5107(98)70217-2.
Fiberoptic flexible sigmoidoscopy (FFS) is routinely requested preoperatively as part of evaluation of pelvic masses to exclude colonic involvement by the tumor or concurrent colonic neoplasm. The aim of our study was to evaluate the utility of preoperative FFS in patients with suspected gynecologic malignancy.
FFS, performed using a 60 cm sigmoidoscope, evaluated (1) presence of bowel involvement by the tumor, (2) extrinsic compression by the tumor, and (3) presence of colonic neoplasms. FFS findings were correlated with surgical findings.
A total of 107 women underwent preoperative FFS and subsequent surgery. Eleven patients (11%) had lower gastrointestinal symptoms. At surgery, 63% of pelvic tumors were malignant and 37% were benign. The most common abnormality at FFS was colonic polyps in 23 patients (21%). Colonic adenomas were found in 11 patients (10%). Extrinsic compression by the tumor without mucosal abnormalities was seen in 15 patients (14%). The most common intraoperative finding was tumor adhering to the bowel in 18 patients requiring dissection, but only 1 patient required bowel resection. Eight of these 18 patients had preoperative lower gastrointestinal symptoms. All 15 patients with extrinsic compression at FFS had tumor adhering to the bowel.
Pelvic masses cause extrinsic compression at FFS in 14% of patients. This is suggestive of tumor adherent to the bowel at surgery. However, bowel resection is rarely required because of tumor involvement. Most patients with bowel adherence by tumor have lower gastrointestinal symptoms. Colonic adenomas are found in one tenth of patients, mostly in patients older than 50 years of age. Preoperative FFS does not change the surgical management of pelvic tumors. Screening FFS is indicated in all patients with pelvic tumors over age 50, as in persons with average risk, but is otherwise unnecessary in evaluation of pelvic masses.
纤维光学可弯曲乙状结肠镜检查（FFS）在术前作为盆腔肿块评估的常规项目，用于排除肿瘤侵犯结肠或同时存在的结肠肿瘤。我们研究的目的是评估术前FFS在疑似妇科恶性肿瘤患者中的应用价值。
使用60cm乙状结肠镜进行FFS，评估（1）肿瘤侵犯肠道情况，（2）肿瘤的外部压迫情况，（3）结肠肿瘤的存在情况。将FFS检查结果与手术结果进行对比。
共有107名女性接受了术前FFS检查及后续手术。11名患者（11%）有下消化道症状。手术中，63%的盆腔肿瘤为恶性，37%为良性。FFS最常见的异常是23名患者（21%）有结肠息肉。11名患者（10%）发现有结肠腺瘤。15名患者（14%）可见肿瘤外部压迫但无黏膜异常。手术中最常见的发现是18名患者肿瘤与肠道粘连需要分离，但只有1名患者需要进行肠切除。这18名患者中有8名术前有下消化道症状。FFS检查有外部压迫的所有15名患者肿瘤均与肠道粘连。
14%的患者盆腔肿块在FFS检查时会导致外部压迫。这提示手术时肿瘤与肠道粘连。然而，因肿瘤侵犯而需要进行肠切除的情况很少见。大多数肿瘤与肠道粘连的患者有下消化道症状。十分之一的患者发现有结肠腺瘤，大多是年龄超过50岁的患者。术前FFS不会改变盆腔肿瘤的手术治疗方式。对于所有50岁以上的盆腔肿瘤患者，如同平均风险人群一样，建议进行FFS筛查，但在评估盆腔肿块时其他情况下则无必要。
