老年人大肠癌内镜诊断和临床特征分析

目的 探讨老年人大肠癌的发病特点、内镜下表现、临床特点及其预后。方法回顾复旦大学附属华东医院2000～2007年间，总计18041例结肠镜检查结果，经结肠镜及病理证实的大肠癌患者有811例，其中老年组（≥60岁）565例，中位年龄73．19岁，复习内镜下表现，分析其临床特点，并与非老年组（〈60岁）作对比分析。结果大肠癌的发病率随着年龄的增加而升高，男女发病率差异无统计学意义。两组均以便血、腹痛、大便习惯改变等为主要症状，老年组贫血和便秘发生率高于非老年组；而腹痛和便血发生率低于非老年组。内镜下老年人大肠癌以肿块型最多见，直肠和乙状结肠仍是好发部位，老年组病例大肠癌的发生率为34．05％，高于非老年组。老年人大肠癌以中、高分化腺癌为主，预后较好。早期癌预后好，同时癌预后差。结论老年人是大肠癌的高危人群，对临床疑诊大肠癌者，应尽早行结肠镜检查。结肠镜检查是早期诊断老年人大肠癌最安全、有效的方法。

Colonoscopic diagnosis and clinical characteristics of colorectal cancer in elderly patients

Objective To explore colonscopic characteristics, clinical features and prognosis of colorectal cancer in elderly patients. Methods A total of 18 041 cases of colonoscopy performed in Huadong Hospital from 2000 to 2007 were retrospectively analyzed. Ofthem, colorectal cancer was confirmed by colonoscopy and histology in Sll cases, including 482 patients older than 65 years （median 74.79 years）. The colonoscopic characteristics and clinical features of this group of patients were analyzed in comparison with the group under 65 years. Results The incidence of colorectal cancer increased with age. The main symptoms were hematochezia, abdominal pain and change in bowel habits in both groups. The rate of anemia, positive fecal occult blood and constipation was significantly higher in the elderly group. Mass type lesions were most common colonoscopic findings in the elderly. The high-risk positions were the rectum and sigmoid colon. The rate of proximal colorectal cancer was on the rise. The prognosis of early stage cancer was better than synchronous cancers. Conclusion Old people are at an increased risk of colorectal cancer. Early colonoscopy should be encouraged in patients with any suspected sign of colorectal cancer. Colonoscopy remains to be the safest and most effective diagnostic method for confirming colorectal cancer in elderly patients.