4450例结直肠肿瘤分布特征及其对结直肠癌筛查的意义

目的 研究人群中结直肠肿瘤的分布特征,并探讨其对结直肠癌筛查工作的指导意义.方法 对南京中医药大学第三附属医院全国肛肠医疗中心2004年10月至2009年6月进行的17 939例结肠镜检查结果进行回顾性研究,观察结直肠肿瘤的性别、年龄及部位分布特征.结果 共诊断结直肠肿瘤4450例（24.8%）,其中结直肠息肉3410例（19.0%）,结直肠腺癌1040例（5.8%）.肿瘤检出率男性明显高于女性（P＜0.01）.结直肠肿瘤检出率从40岁开始明显增加（P＜0.01）,并随年龄的增长逐渐上升.结直肠肿瘤分布以远端结肠（直肠、乙状结肠）为主,占63.3%,近端结肠占36.7%.其中息肉局限于远端结肠者1802例（52.8%）、局限于近端结肠者1049例（30.8%）、同时位于近、远端结肠者559例（16.4%）.癌肿位于远端结肠者921例（88.6%）,位于近端结肠者118例（11.3%）,同时位于近、远端结肠1例（0.1%）.结论 乙状结肠镜检查不足以对全结肠肿瘤进行筛查,采用全结肠镜检查进行结直肠癌的筛查更具优势.

Distribution characteristics of colorectal neoplasm in 4450 patients and implication for colorectal cancer screening

Objective To study the distribution characteristics of colorectal neoplasm and evaluate the implication for colorectal cancer screening.Methods A total of 17,939 colonoscopies were performed in the National Center of Colorectal Surgery between October 2004 and June 2009.Characteristics of colorectal neoplasm including anatomical distribution,sex,and age were investigated.Results Colorectal neoplasm was found in 24.8%(4450/17,939) of the patients during colonoscopy,including adenomatous polyp (n=3410,19.0%) and adenocarcinoma (n=1040,5.8%).The prevalence of colorectal neoplasm was higher in male and significantly increased in patients older than 40 years.63.3% of the lesions located at the distal colon (sigmoid colon and rectum) and 36.7% at the proximal colon (36.7%).In patients with adenomatous polyp,52.8%(1802/3410) of the lesions were at the distal colon,30.8% (1049/3410) at the proximal colon,and 16.4% (559/3410) at both distal and proximal colon.In patients with carcinoma (n=1040),921 (88.6%) lesions located at the distal colon,118(11.3%) at the proximal colon,and 1(0.1%) at both segments.Conclusion Sigmoidoscopy is inadequate for colorectal cancer screening as compared to colonoscopy.