50例结直肠癌术后结肠镜检查结果分析

目的：探讨结直肠癌术后定期结肠镜检查的必要性。方法：回顾性分析1989年10-2005年10月50例结直肠癌术后患者结肠镜检查及病检结果，并对其结果进行分析和总结。结果：发现大肠癌复发或再发6例（其中吻合口复发癌5例。直肠息肉恶变1例）。发生率为12％；吻合口重度不典型增生1例；大肠息肉8例（吻合口息肉3例，其他部位5例，其中腺瘤性息肉4例）；吻合口炎4例；病变检出率为38％。结论：结直肠癌术后可再发良、恶性病变，结肠镜检查应列为常规检查。以便及时发现病变并作相应治疗。     

结肠镜联合腹腔镜诊治直肠癌合并结直肠息肉的探讨(附25例报告)

目的探讨直肠癌合并结直肠息肉的发生情况及腹腔镜结肠镜对直肠癌合并结直肠息肉的处理方法。方法回顾分析2003年1月～2006年12月该院25例直肠癌合并结直肠息肉行腹腔镜结肠镜处理患者的临床资料。结果直肠癌患者结肠镜检查结直肠息肉的检出率为24.10%,显著高于同期结肠镜检查结直肠息肉检出率的12.19%(P<0.01)。直肠癌行腹腔镜直肠癌根治术。腹腔镜直肠癌根治术术前、术中行结肠镜息肉摘除16例;术前结肠镜下注射亚甲蓝标记或术中结肠镜引导,腹腔镜行直肠癌根治术的同时行含息肉的结肠部分切除5例;直肠癌合并升结肠息肉恶变行腹腔镜直肠癌根治术同时行右半结肠切除1例;息肉靠近直肠癌一并行直肠癌根治性切除3例。结直肠息肉切除率100%,未出现并发症。25例术后随访0.5年～4.0年,2例死于肿瘤转移,23例存活,无肿瘤或息肉复发。结论直肠癌患者合并结直肠息肉的发生率较高。腹腔镜直肠癌根治性切除术术前或术中有必要行结肠镜检查,同时根据息肉情况选择结肠镜息肉切除或腹腔镜下息肉切除。     

结肠镜检查在结直肠癌术后随访的临床意义

目的探讨结直肠癌术后定期结肠镜检查的必要性。方法回顾性分析1998年1月～2004年1月113例结直肠癌术后患者结肠镜检查及活栓结果。对其结果进行分析和总结。结果发现大肠癌复发或再发9例(其中吻合口复发6例，非吻合口大肠癌2例，直肠息肉恶变1例)，发生率达7．9％；吻合口重度不典型增生1例；大肠息肉19例(吻合口息肉9例。其他部位10例，其中腺瘤性息肉6例)，病变检出率25．7％(29／113)。结论结直肠癌术后可再发良、恶性病变，结肠镜检查应作为常规检查，以便及时发现病变并作相应治疗。     

^18F-FDG PET-CT及血清CEA检测在结直肠癌术后诊断及治疗中的临床应用价值

目的探讨^18F-FDG PET-CT检查和血清CEA检测在结直肠癌术后诊断、随访及治疗中的临床应用价值。方法61例结直肠癌术后患者均进行了^18F-FDG PET显像,并对其中32例资料完整的患者血清CEA进行了统计比较。结果（1）结直肠癌的术后复发转移灶在^18F-FDG PET-CT图像上均表现为局部放射性摄取增高,呈团块状或点状,复发灶常沿肠管走行。（2）61例结直肠癌术后患者中,PET-CT最终正确诊断58例,其灵敏度为97.2%,特异性为92%,准确性为95.1%。（3）本组病例中,经过^18F-FDG PET-CT检查,对52.5%的患者修正了肿瘤分期或治疗方案。（4）结直肠癌患者血清CEA检测,术后组与术前组比较差异有统计学意义（P〈0.05）;随访升高组与术后组比较差异有统计学意义（P〈0.05）。结论（1）^18F-FDG PET-CT检查在诊断结直肠癌术后患者复发转移、修正分期和治疗方案及监测近期疗效方面有重要临床价值。（2）在结直肠癌术后患者中,血清CEA敏感性好,对监测疗效和复发有重要的临床参考价值。     

电子肠镜在腹腔镜结直肠切除术中的应用

目的探讨电子肠镜在腹腔镜结直肠切除术中的应用价值。方法2001年5月～2006年12月627例患者成功进行了腹腔镜结直肠切除术,94例同时进行术中电子肠镜检查。结果术中电子肠镜检查94例,其中肿块定位13例,术前肠镜不能通过的肿块近端肠管检查80例（74例成功进行,发现近端肠管有小息肉12例均未行活检;直径大于5mm息肉3例,术中快速冷冻活检未见癌;行术中息肉电切术1例,6例因存在不全结肠梗阻导致肠道准备差而失败）,术中明确肠吻合口出血1例。无手术死亡,检查后1例出现肠穿孔,3例浆膜撕裂。结论对小肿瘤和术前肠镜不能通过又未进行成功的CT仿真结肠镜检查的患者（右半结肠癌患者除外）实施腹腔镜手术时,需要进行术中电子肠镜检查,以方便小病灶的定位和排除近端多原发癌灶。     

1000例电子结肠镜检查结果的回顾性分析及临床研究

【】：目的：回顾性分析电子结肠镜的检查结果,为临床合理应用电子结肠镜提供指导意见。方法：选取我院2012年1月至2016年10月期间接受电子结肠镜检查的1000例患者的临床资料进行回顾性分析,对大肠病变的检出情况进行分析,归纳总结各类大肠病变的发病年龄、性别等特点。结果：1000例患者经电子结肠镜检查共检出594例大肠病变,前三位疾病分别为结直肠息肉、结直肠炎、结直肠癌,占比分别为45.96%、36.20%、13.30%。结直肠息肉的发病年龄以中老年为主,结直肠炎的发病年龄以青年为主,结直肠癌的发病年龄以老年为主。结直肠息肉在男性中的发病率高于女性,结直肠炎、结直肠癌在男性中的发病率低于女性,P<0.05。结论：电子结肠镜检查对大肠病变的筛查与诊断具有重要的价值,临床检查时应结合相关病变对高发人群实施加强电子结肠镜检查,以加强大肠病变的早期防治。     

异时性多原发性结直肠癌13例临床分析

目的:为探讨异时性多原发性结直肠癌的临床病理特点和诊治特点.方法:回顾分析13例异时性多原发性结直肠癌患者的病例资料,结合文献报道对异时性多原发性结直肠癌的发病状况,发病因素,诊断治疗及预后进行讨论.结果:异时性多发性结直肠癌病例占同期所有收治结直肠癌的1.36％(13/955),占多发性结直肠癌的34.21％(13/38),平均间隔时间为2.8年,均为肠镜随访发现,13例患者首发癌均行手术切除,再发癌以Dukes B期多见.结论:异时性多原发性结直肠癌临床病理学特点突出,应重视术后肠镜复查,早期发现,积极手术,提高患者生存率.     

多原发结直肠癌63例临床分析

目的探讨多原发结直肠癌(MPCC)的临床病理特点、诊断、治疗及预后。方法回顾性总结本院63例MPCC患者的临床资料,分析肿瘤发生、分布及治疗与预后。结果 MPCC占同期收治的结直肠癌的2.1%(63/3021),其中同时性结直肠癌(SC)31例(49.2%),异时性结直肠癌(MC)32例(50.8%)。男女比例为2.5∶1。癌灶分布以直肠、乙状结肠为多。病理类型以腺癌为多,占77.8%(105/135);黏液腺癌次之,占13.3%(18/135)。TNM分期以Ⅱ期最多,占47.4%(64/135)。术前纤维结肠镜诊断34例(54.0%)。SC组术前纤维结肠镜诊断12例(38.7%),术中探查诊断12例(38.7%);MC组术前纤维结肠镜诊断22例(68.7%),术中探查诊断2例(6.25%)。SC组术后5年生存率为45%(9/20),MC组首次癌术后5年生存率为72.4%(21/29)。结论 MPCC与结直肠腺瘤之间有密切关系,应重视纤维结肠镜随访,对合并的腺瘤或息肉,应及时治疗,防止腺瘤癌变,减少异时癌的发生。诊断上对于结直肠癌患者应着重强调术前纤维结肠镜活检;治疗上应争取早期行根治性切除术。     

结肠阳性造影CT仿真肠镜对结肠息肉诊断价值

目的 评价结肠阳性造影CT仿真结肠镜用于诊断结直肠息肉的价值.方法 57例疑似或确诊后复查的结直肠息肉患者纳入研究,所有患者先进行结肠阳性对比剂充盈下CT仿真结肠镜检查,然后患者再行电子肠镜检查,影像科医生及内镜医生均在盲法干预下出具各自检查报告,由第三方统计人员统计CT仿真肠镜对结直肠息肉诊断的符合率.结果 以电子肠镜为金标准,则CT仿真结肠镜患者检出敏感度为95.23 %,特异度为 93.33 %;电子肠镜共检出90例息肉,仿真结肠镜共检出125例息肉.仿真结肠镜发现直径在0.3 cm以上的病灶93处,电子内镜有 90 处,对所有检出直径在0.3 cm以上病灶进行点对点比较,二者的吻合率为86.67 %,仿真结肠镜诊断的假阳性率为16.67 %,假阴性率为13.33 %.结论 阳性对比剂充盈下仿真结肠镜能提高结肠息肉的诊断效率.     

1 000例电子结肠镜检查结果回顾性分析

目的:回顾性分析电子结肠镜的检查结果,为临床合理应用电子结肠镜提供指导意见。方法:选取我院2012年1月~2016年6月接受电子结肠镜检查的1 000例患者的临床资料进行回顾性分析,对大肠病变的检出情况进行分析,归纳总结各类大肠病变的发病年龄、性别等特点。结果:1 000例患者经电子结肠镜检查共检出594例大肠病变,前三位疾病分别为结直肠息肉、结直肠炎、结直肠癌,在总检查人数中占比分别为27.30%、21.50%、5.90%。结直肠息肉、结直肠癌的发病年龄以中老年为主,结直肠炎的发病年龄以青年为主。结直肠息肉在男性中的发病率高于女性,结直肠炎、结直肠癌在男性中的发病率低于女性,P0.05。结论:电子结肠镜检查对大肠病变的筛查与诊断具有重要的价值,临床检查时应结合相关病变对高发人群实施加强电子结肠镜检查,以加强大肠病变的早期防治。     

PillCam colon capsule endoscopy compared with colonoscopy for colorectal tumor diagnosis: a prospective pilot study

BACKGROUND AND AIMS: Colonoscopy is regarded as the gold standard for colorectal cancer (CRC) screening. PillCam capsule endoscopy could be an alternative approach for screening large populations. We report a pilot evaluation in humans of the safety, feasibility, and performance of colon capsule endoscopy compared with colonoscopy. PATIENTS AND METHODS: Patients included in this single-center comparative study had presented for screening colonoscopy or there was suspicion of polyps or CRC. The capsule was ingested in the morning. After excretion, colonoscopy was performed. Significant findings were defined either as polyps > 6 mm, or three or more polyps of any size. Colonoscopy and colon capsule endoscopy (CCE) review were performed by independent physicians. RESULTS: 41 patients (26 women), mean age 56 years (range 26 - 75) were included, and all had complete colonoscopies. Four patients were excluded due to technical problems and one could not swallow the capsule; thus, 36 patients were considered in the analysis. In six the capsule had not been expelled at 10 hours and was retrieved endoscopically. CCE identified 19 of the 25 patients (76 %) with positive findings and 10 of the 13 (77 %) with significant lesions detected by colonoscopy. CCE detected seven lesions not seen at colonoscopy and two tumors were detected by both examinations. Overall sensitivity of CCE to detect significant lesions was 77 %, specificity was 70 %, positive predictive value was 59 %, and negative predictive value was 84 %. No adverse events occurred. CONCLUSION: CCE showed promising accuracy compared with colonoscopy. This new noninvasive technique deserves further evaluation as a potential CRC screening tool.     

Risk of Colorectal Cancer After Colonoscopy Compared With Flexible Sigmoidoscopy or No Lower Endoscopy Among Older Patients in the United States, 1998-2005

ObjectiveTo determine whether the risk of colorectal cancer (CRC) decreases after colonoscopy compared with sigmoidoscopy or no lower endoscopy.Patients and MethodsPatients 67 to 80 years old in the 5% random Medicare sample of the Surveillance, Epidemiology and End Results and Medicare–linked database were grouped into those who underwent colonoscopy or flexible sigmoidoscopy from January 1, 1998, through December 31, 2002, and those who did not undergo lower endoscopy. We excluded patients with inflammatory bowel disease, history of colon polyps, or family history of CRC. All patients were followed up until the diagnosis of CRC or carcinoma in situ, death, or December 31, 2005. The risk of CRC after colonoscopy was compared with the risk after sigmoidoscopy or no lower endoscopy. The multivariate Cox proportional hazards model was used in statistical analysis.ResultsIn the colonoscopy group (n=12,266), 58 CRCs (0.5%) were diagnosed during follow-up compared with 66 CRCs (1.0%) in the sigmoidoscopy group (n=6402) and 634 (1.5%) in the control group (n=41,410) (all P<.001). In the sigmoidoscopy group, 771 patients (12.0%) underwent colonoscopy within the next 12 months. In multivariate Cox regressions, colonoscopy was associated with a decreased risk of distal CRC (hazard ratio [HR], 0.266; 95% CI, 0.161-0.437) and proximal CRC (HR, 0.451; 95% CI, 0.305-0.666); sigmoidoscopy was associated with a decreased risk of distal CRC (HR, 0.409; 95% CI, 0.207-0.809) but not proximal CRC.ConclusionAmong older patients, the risk of distal CRC decreased after both colonoscopy and sigmoidoscopy; the risk of proximal CRC decreased after colonoscopy but not sigmoidoscopy.     

Clinical significance of small polyps found during screening with flexible sigmoidoscopy

In deciding how to interpret the significance and management of small distal adenomatous polyps found on FS, one must first decide on the goal of a screening program. If the goal is maximal reduction of CRC risk, regardless of cost, there is little argument that screening colonoscopy is the most effective approach. Unfortunately cost and cost-effectiveness are important considerations when administering a screening program with a fixed budget. Although comparing the cost-effectiveness of different strategies is beyond the scope of this article, rigorous comparisons by other authors have suggested that a sigmoidoscopy-based approach is more cost-effective than a colonoscopy-based approach. The most cost-effective approach may change, however, if the frequency of screening and surveillance can be reduced without significantly impacting effectiveness. Other authors using assumptions including low compliance rates for regular FOBT or FS have determined that colonoscopy every 10 years is the most cost-effective approach. Multiple studies support the recommendation that villous polyps regardless of size and adenomatous polyps greater than 1 cm found on FS are important markers for the presence of advanced polyps and cancer in the proximal colon. These patients should undergo colonoscopy. If one assumes that a sigmoidoscopy-based approach is reasonable, and accepts that such an approach always misses a small number of proximal lesions, how should one manage patients with a small adenomatous polyp on FS? In aggregate, the studies discussed previously suggest that patients with no distal polyps, distal hyperplastic polyps, or a single small distal tubular adenoma have a similar and low risk of advanced proximal adenomas of the colon. There are some studies, however, that do not support this. With the exception of the study by Read et al, these studies included patients at elevated risk of CRC because of a family history, or inclusion of patients with positive FOBT (or not tested). The study by Read et al also included patients with distal villous adenomas in their low-risk group. Because a sigmoidoscopy-based strategy typically excludes patients at elevated risk, these results may not be applicable to low-risk patients undergoing sigmoidoscopy. Given these caveats, what can one conclude about the predictive value of a small tubular adenoma found on FS? These studies suggest that the risk of proximal advanced polyps is similar or slightly increased in patients with a distal adenoma than those with a negative FS. The risk of finding an advanced adenoma seems to be 0% to 4% regardless of the findings of no polyps, hyperplastic polyps, or small tubular adenomatous polyps on FS in low-risk patients. A small portion of patients with hyperplastic polyps found on FS have advanced proximal adenomas. If a hyperplastic polyp on FS is not an indication for colonoscopy and the risk of proximal advanced adenomas is similar in patients with only a small distal adenoma, it is inconsistent to recommend colonoscopy for a small distal tubular adenoma and not a hyperplastic polyp. Based on the studies of asymptomatic patients with no family history and negative FOBT, the authors believe it is reasonable to defer colonoscopy if no polyp, a hyperplastic, or a small tubular adenoma is found at sigmoidoscopy in low-risk patients. If the patient or physician is unwilling to accept a small (0% to 4%) chance of missing an advanced proximal lesion, then a sigmoidoscopy-based approach (regardless of the threshold to go on to colonoscopy) is not appropriate. Screening FS remains an effective examination to screen for CRC in asymptomatic patients. There is no question that colonoscopy clearly detects more lesions than FS. It remains to be seen if the increase in costs and risks justifies the improved detection rate of colonic polyps. Given manpower issues that face us today, and examining the question from a population perspective, reserving colonoscopy for only those patients with an advanced distal polyp on FS gives the biggest yield.     

上海市嘉定地区3509例结肠镜筛查中无症状肿瘤性疾病比对研究

目的:探讨症状性及无症状人群中结肠直肠肿瘤性疾病的分布规律,以期更好地指导今后的临床及科研工作。方法:收集2013年1月至2014年2月间上海交通大学医学院附属瑞金医院北院就诊的3 509例结肠镜检查人群基本信息,包括性别、年龄、发病时的症状、结肠镜检查结果及相关病理检查结果。将受检者分为症状筛查组(如腹痛、腹泻、黏液便、腹胀等)和无症状筛查组(粪便隐血试验阳性),进行统计学分析以期找出其中的相同及差异。结果:3 509例结肠镜受检者的平均年龄为(55±13)岁,按症状分为症状筛查组和无症状筛查组(639例)。3 509例受检者的结肠直肠息肉检出率为34.4%,结肠直肠癌检出率为2.6%。男女性别间的病灶检出率无差异,而60~69岁受检者的恶性肿瘤占所有检出肿瘤构成比为44.0%。所有结肠直肠癌以远端结肠(直肠、乙状结肠)为主(66.7%);结肠直肠息肉与结肠直肠癌并存患者数占结肠直肠癌总数的36.6%。症状筛查组的结肠直肠息肉检出率为33.0%,结肠直肠癌检出率为2.5%;无症状筛查组的结肠直肠息肉检出率为41.2%,结肠直肠癌检出率为3.2%。2组间的结肠直肠息肉检出率差异有统计学意义,而结肠直肠癌检出率差异无统计学意义。结论:上海市嘉定地区接受结肠镜检查人群的结肠直肠息肉检出率较高,针对粪便隐血筛查阳性的无症状人群进行结肠镜检查,对于早期发现结肠直肠肿瘤有重要意义。     

Hereditary colorectal cancer

This article summarizes the genetics of colorectal cancer (CRC), a disease in which 15% to 20% of cases are inherited. Familial adenomatous polyposis and hereditary nonpolyposis CRC represent the two most common forms of inherited CRC. One particular mutation, APC11307K, is associated with CRC in certain Jewish populations. Inherited cancers can be prevented with careful attention to regular and frequent sigmoidoscopy or colonoscopy screening intervals and the prompt removal of premalignant polyps. The role of the nurse should include the prompt identification and referral of high-risk individuals. Ongoing patient and family counseling and education, multidisciplinary collaboration, support for primary prevention, and intensive screening are essential.     

Screening and surveillance of colorectal cancer

Although colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States, it is preventable. Screening modalities include fecal occult blood testing, flexible sigmoidoscopy, double-contrast barium enema, and colonoscopy. Colonoscopy allows effective detection and removal of precursor adenomatous polyps and is the dominant CRC screening modality. Emerging technologies include CT and MR colonography and fecal DNA tests. Effective and cost-effective surveillance after polypectomy and curative CRC resection requires balancing the protective effect of polypectomy while maximizing intervals between examinations; thus, estimation of the risk of recurrence determines the intensity of surveillance for individual patients.     

Colonoscopy and multidetector-array computed-tomographic colonography: detection rates and feasibility

BACKGROUND AND STUDY AIMS: Computed-tomographic (CT) colonography has been introduced as a minimally invasive colon examination for the detection of colorectal neoplasms. The aim of this study was to compare the performance characteristics of multidetector-array CT colonography (MDCTC) and conventional colonoscopy in a prospective, blinded design. PATIENTS AND METHODS: Sixty-six symptomatic patients, 75 patients undergoing polyp and cancer surveillance, and seven patients undergoing preoperative colonoscopy due to colorectal cancer (CRC) were examined with MDCTC and subsequent colonoscopy. The gold standard was colonoscopy. If MDCTC was positive and the first-pass colonoscopy was negative, a second-pass colonoscopy served as the gold standard. RESULTS: Complete colonoscopy was achieved in 91% of the patients, while technically satisfying MDCTC was obtained in 76% of the patients (P < 0.01), insufficient air distension in the sigmoid colon being the main problem. MDCTC and colonoscopy both detected all 11 carcinomas. Overall detection rates for polypoid lesions 6 mm or larger in size were 81% (95% CI, 70% to 90%) for MDCTC and 87% (95% CI, 77% to 94%) for colonoscopy (P = 0.52), with a significant difference with regard to the detection of polyps 6-9 mm in size in favor of colonoscopy (P = 0.008). The specificity of MDCTC at a 6-mm level was 97% (95% CI, 92% to 99%). CONCLUSIONS: MDCTC and colonoscopy show equal overall sensitivity for the detection of polypoid lesions 6 mm or larger in size, but more patients are inadequately examined when MDCTC is used.     

普通内镜结合靛胭脂染色在鉴别瘤性与非瘤性大肠息肉中的价值

目的探讨普通内镜结合靛胭脂染色在鉴别瘤性与非瘤性大肠息肉中的价值。方法对124个大肠息肉分别行普通内镜及靛胭脂染色内镜诊断,若息肉表面呈沟槽状、脑回状或分叶状结构则定义为瘤性息肉,若表面光滑或有规则小圆点状小凹就定义为非瘤性息肉,并与组织学结果比较,比较2种内镜诊断方法鉴别瘤性与非瘤性大肠息肉的诊断准确率、特异性和敏感性。结果靛胭脂染色内镜鉴别瘤性与非瘤性大肠息肉的诊断准确率显著高于普通内镜(85.48% vs 70.16%,P<0.005)。染色内镜鉴别瘤性与非瘤性大肠息肉的敏感性和特异性分别为86.11%、84.62%,显著高于普通内镜的72.22%、67.31%(P<0.05)。结论普通内镜结合靛胭脂染色可较准确地鉴别瘤性与非瘤性大肠息肉,有助于实时指导内镜下对大肠息肉的处理方式。