结肠镜对诊断大肠多原发癌的作用

大肠多原发癌和腺瘤是引起大肠癌术后复发的重要原因。大肠癌术前全结肠的肠镜检查、术后的肠镜随访、肠镜下积极治疗癌前病变——大肠腺癌,是提高大肠多原发癌的诊断和降低发生率的重要手段。 临床资料 1973～1991年共行结肠镜检查2600例,发现大肠癌163例(6.3％),其中大肠多原发癌22例(13.5％)。男13例,女9例。年龄18～20岁3例,29     

多原发大肠癌的内镜诊断及其与腺瘤的关系

目的提高临床医师对多原发大肠癌的重视程度,研究腺瘤与肠癌的关系。方法总结８４３例大肠癌中多原发癌２２例（同时癌１７例,异时癌５例）的临床资料。结果多原发癌检出率２．６１％;２２例共有癌灶４９个,乙状结肠以下占６２．６％;２２例中共检出腺瘤３１个,癌变息肉达６１．２％,亦多分布在乙状结肠和直肠。结论多原发大肠癌并不少见,多原发大肠癌与腺瘤之间关系密切。对大肠癌患者行肠镜检查时,对所见息肉均应常规活检,并治疗,以减少多原发大肠癌的发生。     

大肠镜在大肠癌切除术中的应用

大肠镜检查诊断大肠多原发性癌，能使一次手术及时切除大肠内多个原发病灶，有利发现早期多原发癌和防止癌前期病变——大肠腺瘤术后演变为第二、第三原发癌有主要意义，现报道如下。一、材料与方法：１９８７年１月至１９９５年１２月，５８９例大肠癌患者术前常规用大肠...     

大肠癌高危人群结肠镜检查追踪随访

目的：大肠癌在消化道肿瘤中预后较好，如能较早的发现和及时治疗，完全可以根治。方法：对1125例大肠癌高危人群进行结肠镜的追踪随访检查，结果：发现大肠癌37例（3．3％），其中28例（75．7％）为无淋巴结转移的早期癌，发现癌前期病变一大肠腺瘤215例（19．1％）。结论：结肠镜对大肠癌高危人群进行定期追踪检查是发现早期大肠癌和癌前期病变－腺瘤最方便、最安全、最简便的方法。     

异时大肠多原发癌7例报告

1993年1～12月，我们对97例大肠癌切除术后患者进行随访。发现异时大肠多原发癌7例。现报告如下。临床资料：本文97例大肠癌患者均经病理证实，行根治切除术。术后每3个月、半年后每6个月常规行纤维结肠镜检查1次，如有便血、梗阻症状则随时做相应检查。共发现异时大肠多原发癌7例，其中复查检出2例，因便血、梗阻症状复查检出5例。男6例，女1例；年龄41～74岁。首次癌位于乙状结肠3例．回盲部2例，直肠、结肠肝曲各1例；腺癌4例。未分化癌2例，黏液腺癌1例；Dukes分期B期3例，C期4例。再次癌位于回盲部3例，直肠2例，乙状结肠、吻合口各1例；腺癌5例，黏液腺癌2例；Dukes分期B期1例，C期5例，D期1例。首次癌与再次癌间隔时间7个月至10a，平均3．9a。     

大肠癌精筛中内镜黏膜切除术对结直肠进展期腺瘤的诊治价值

目的探讨内镜黏膜切除术(EMR)在大肠癌精筛中诊治结直肠进展期腺瘤的临床价值。方法收集2016-01～2017-05广州市中西医结合医院结肠镜活检诊断为结直肠广基或亚蒂进展期腺瘤52例,行EMR切除病灶,并行病理学检查明确诊断,随访观察治疗效果和安全性。结果 47例病变予EMR切除,5例予内镜黏膜分片切除术(EPMR)切除,术中出血5例,均20 ml,术后无迟发型出血及穿孔发生。所有病变一次性整块切除率为90. 4%(47/52),组织治愈性切除率为88. 5%(46/52);术后病理提示绒毛状腺瘤或管状绒毛状腺瘤伴低级别上皮内瘤变(LGD) 38例(73. 1%),绒毛状腺瘤或管状绒毛状腺瘤伴高级别上皮内瘤变(HGD) 12例(23. 1%),另有2例(3. 8%)黏膜下癌转外科手术治疗,但术后病变肠段未发现肿瘤组织残留和淋巴结转移。50例患者术后随访3～15月(中位随访9个月)未见复发。结论 EMR诊治进展期腺瘤安全有效,在大肠癌精确筛查中能发挥关键的诊治价值。     

多原发大肠癌12例临床分析

198 2年 3月～ 1999年 3月 ,我院手术治疗大肠癌 42 6例 ,其中多原发癌 12例。报告如下。临床资料 :本组男 8例 ,女 4例 ;年龄 46～ 73岁。同时性癌 4例 ,异时性癌 8例 ,其间隔时间为 2～ 13年。发生部位以横结肠和直肠为多。病理以中分化腺癌为多。合并大肠腺瘤 4例。异时癌多因患者腹胀、腹泻、大便带血腹部肿块而就诊 ,或术后随访肠镜检查时发现。均采用手术治疗 ,4例同时性癌均施行根治性切除 ,5年存活率 75 % ;8例异时癌中 ,根治性切除 4例 ,肠段切 2例 ,姑息切除 1例 ,肠造口 1例 ,5年存活率 37.5 %。其中 2例肠段切除均已 5年 ,仍健…     

肠镜检出增生性息肉的临床意义

近年调查表明，增生性息肉常与腺瘤和癌伴存，与大肠癌有一些生物学方面的共性，因此对增生性息肉在大肠癌发生学中的作用及直肠己状结肠镜检查发现该息肉时是否应作全结肠镜检查等问题引起人们的重视。我们对近年检出的126例病人进行分析，与同期腺瘤病人比较，并对部份病人进行随访，以期探讨肠镜检出增生息肉的临床意义。     

高龄人群连续性大肠肿瘤普查的必要性和可行性

目的　探讨高龄人群结肠癌普查的可行性和必要性。方法　对１６３８ 名无症状老年人（６０ － ９０ 岁） 连续１１年每年行粪便序贯隐血筛检（ＳＦＯＢＴ） 一次，ＳＦＯＢＴ 阳性者予全结肠肠镜检查。结果　每年普查率约为８０ ％ ，计１３１０ 人。共检出大肠癌１２ 例，大肠腺瘤１３０ 例，其年发病率分别为６６－６０／１０ 万及７２－１５／１０ 万。在１１ 年连续筛检的个体中，检出大肠癌３ 例。未连续检查的个体中，检出大肠癌９ 例。１３０ 例大肠腺瘤均于结肠镜下切除，随访１１ 年无１ 例癌变。结论　高龄人群是大肠癌的高危人群，大肠癌普查可提高可愈癌和腺瘤的检出。因此提高筛检的敏感性和依从性是可治愈大肠癌检出的关键因素。切除大肠腺瘤可预防大肠癌的发生     

SPA免疫便潜血试验和直肠粘液T抗原试验互补普查大肠癌及其随访

本文联合采用人血红蛋白抗血清包被的含A蛋白葡萄球菌(SPA)进行免疫便潜血试验(SPA试验)和直肠粘液T抗原检测(T抗原试验)用于大肠癌普查初筛并对筛检人群进行随访。结果表明,在4843例无症状人群中,SPA和T抗原试验阳性者分别为472例(9.75％)和297例(6.13％).共769例阳性者行纤维结肠镜检查,检出大肠癌4例,腺瘤48例(>1.0cm者17例,占35.4％)。其中,SPA试验中仅3例癌,29例腺瘤阳性,T抗原试验中2例癌,27例腺瘤阳性,提示联合这两种初筛试验可提高大肠癌及其腺瘤的检出率。为验证普查后减少大肠肿瘤发生的效果,2年后对这些人群采用同样的普查方案随访,结果在受检的3641例人群中,共477例阳性者行纤维结肠镜检查,未发现大肠癌病例,腺瘤18例(>1.0cm者仅4例,占22.2％)。将两次检出的腺瘤进行不典型增生程度的比较,第二次检出的腺瘤轻度不典型增生病变占88.89％(16例),中重度不典型增生病变仅占11.11％(2例),而第一次检出腺瘤、中重度不典型增生病变占25％(12例)。上述结果表明利用这两种初筛试验进行互补性普查。可提高大肠癌及癌前病变的检出率,随访结果提示在无症状人群普查,不仅可使大肠癌及腺瘤的再检出率明显减少,且可使中重度不典型增生病变的发病机会明显减少。     

窄带成像技术对大肠增生性病变的诊断价值研究

目的探讨窄带光谱成像技术（NBI）对大肠增生性病变的诊断价值。方法在白光及NBI模式下分别对大肠可疑病灶进行观察、诊断,以活检病理学检查结果作为金标准,对比NBI与传统肠镜诊断大肠炎性增生、腺瘤、早癌及进展期肿瘤的敏感性及特异性。采用NBI模式结合放大内镜观察各种大肠增生性病灶的腺管开口分型及病灶表面微血管形态并进行评分,总结NBI下大肠各种增生性病灶的内镜下特点。结果（1）传统肠镜及NBI技术检查280例患者共发现368处病灶,NBI诊断大肠炎性增生、腺瘤及早癌的敏感性及特异性明显高于传统肠镜。（2）NBI下大肠炎性增生的腺管开口多为Ⅰ、Ⅱ型,腺瘤多为Ⅱ、Ⅲ型（共占94．2％）,早癌的腺管开口可为Ⅲ（18．8％）、Ⅳ（56．3％）和Ⅴ型（25．0％）,进展期肿瘤多为Ⅴ型开口（94．0％）。（3）NBI下大肠炎性增生、腺瘤、早癌及进展期恶性肿瘤的微血管形态学平均评分分别为1．35±0．72、3．86±1．07、6．52±2．59和11．42±3．59,评分在6．5分以上病灶高度提示为恶性病灶。结论NBI在鉴别诊断大肠增生性病灶的敏感性及特异性明显高于传统肠镜,NBI结合放大内镜对病灶腺管开口分型及微血管形态的观察能帮助预测病灶的病理性质。     

窄带成像放大内镜鉴别大肠肿瘤性与非肿瘤性病变的价值

目的 探讨窄带成像放大内镜（NBI—ME）鉴别大肠肿瘤性与非肿瘤性病变表面网状微血管结构改变的临床价值。方法选择常规内镜检出大肠肿瘤性、非肿瘤性病变144处（102例）,记录NBI—ME观察病变表面微血管结构（CP）形态和染色放大内镜观察病变黏膜表面腺管开口（pit）形态。分析pit周围CP形态变化,比较两者形态间的关系。所有病变经内镜或手术治疗后行组织病理学检查。结果常规内镜鉴别病变是否为肿瘤性的准确率75．7％、敏感性85．1％、特异性40．0％,明显低于NBI—ME和染色放大内镜（P〈0．005）,NBI—ME和染色放大内镜间则未见差异。CP分型与pit分型对照,CP—Ⅰ型、Ⅱ型、Ⅳ型、Ⅵa型分别与pitⅠ型、Ⅱ型、Ⅳ型、Ⅴ1型间一致性达100％。144处病变中,内镜治疗129处,手术治疗15处。组织病理学检查：非肿瘤性30处（增生性息肉17处、炎症性息肉13处）;肿瘤性114处（腺瘤95处、腺癌19处）。结论初步显示NBI—ME和染色放大内镜之间具有正相关性,两种检查方法互补可作为当前鉴别大肠病变是否为肿瘤性的重要手段。     

Predictive factors for detecting colorectal carcinomas in surveillance colonoscopy after colorectal cancer surgery

PURPOSE: The aim of this study was to identify the high-risk groups for metachronous colorectal carcinoma among patients who undergo colorectal cancer surgery. METHODS: Three hundred forty-one patients undergoing colorectal cancer surgery who had undergone surveillance colonoscopy at least twice during a period of more than three years were analyzed. A metachronous colorectal carcinoma was defined as a new colorectal carcinoma detected by surveillance colonoscopy after surgery. RESULTS: Surveillance colonoscopy was performed 4.6 times per patient during an average of 6.2 years. Twenty-two metachronous colorectal carcinomas in 19 patients were detected, and 14 (64 percent) of 22 were detected within five years of surgery. The cumulative incidence of developing colorectal carcinomas during a five-year period was 5.3 percent. Seventeen (77 percent) of 22 carcinomas were 10 mm or less in size. Ten (71 percent) of the 14 carcinomas in early stages showed a flat appearance. Univariate analysis showed that extracolonic malignancy, coexistence of adenoma, and synchronous multiple colorectal carcinoma were significant predictive factors for detecting colorectal carcinomas in surveillance colonoscopy and that family history of colorectal carcinoma was a possible predictive factor. Multivariate analysis performed with Cox proportional hazards regression model showed that extracolonic malignancy and the coexistence of adenoma were significant predictive factors. CONCLUSION: We recommend that patients with the above predictive factors receive surveillance colonoscopy meticulously and regularly.     

269例结直肠微小息肉内镜、病理特点和处理方式分析

结肠镜检查发现的结直肠息肉以直径≤5mm的微小息肉（DP）最为常见。目前关于DP内镜下处理方式的报道尚少。目的：分析结直肠DP的内镜、病理特点和处理方式,为其临床诊治提供参考。方法：收集2010年1月～2011年4月青岛市市立医院结肠镜检查病例的临床资料．纳人其中发现结直肠息肉并符合DP标准者．凡合并较大息肉（≥6mm）者予以排除。回顾性分析DP的内镜特点、病理性质和处理方式。结果：共纳入结直肠DP病例269例（402枚DP）,占同期息肉检出例数的21．8％,其中180例（66．9％）为单发。43．3％的DP分布于直肠、乙状结肠,60．0％的DP直径〉3mm,绝大多数DP形态为山田I型（53．5％）或山田Ⅱ型（42．0％）。305枚送病理检查的DP中．绝大多数为腺瘤性息肉（50．2％）或炎性息肉（47．5％）：〉3mm的DP为腺瘤性的可能性较大,≤3mm者多为非肿瘤性（P〈0．05）。66．9％的DP系以活检钳钳除：〉3mm、山田Ⅱ＋Ⅲ型和多发DP采用热活检钳钳除或高频电凝切除的可能性较≤3mm、山田I型和单发DP更大（P〈0．05）。结论：对于直径〉3mm的结直肠DP,行内镜下高频电凝切除可能更为有效,并应送病理检查,以免漏诊进展期腺瘤。     

Five-year colon surveillance after screening colonoscopy

BACKGROUND & AIMS: Outcomes of colon surveillance after colorectal cancer screening with colonoscopy are uncertain. We conducted a prospective study to measure incidence of advanced neoplasia in patients within 5.5 years of screening colonoscopy. METHODS: Three thousand one hundred twenty-one asymptomatic subjects, age 50 to 75 years, had screening colonoscopy between 1994 and 1997 in the Department of Veterans Affairs. One thousand one hundred seventy-one subjects with neoplasia and 501 neoplasia-free controls were assigned to colonoscopic surveillance over 5 years. Cohorts were defined by baseline findings. Relative risks for advanced neoplasia within 5.5 years were calculated. Advanced neoplasia was defined as tubular adenoma greater than > or =10 mm, adenoma with villous histology, adenoma with high-grade dysplasia, or invasive cancer. RESULTS: Eight hundred ninety-five (76.4%) patients with neoplasia and 298 subjects (59.5%) without neoplasia at baseline had colonoscopy within 5.5 years; 2.4% of patients with no neoplasia had interval advanced neoplasia. The relative risk in patients with baseline neoplasia was 1.92 (95% CI: 0.83-4.42) with 1 or 2 tubular adenomas <10 mm, 5.01 (95% CI: 2.10-11.96) with 3 or more tubular adenomas <10 mm, 6.40 (95% CI: 2.74-14.94) with tubular adenoma > or =10 mm, 6.05 (95% CI: 2.48-14.71) for villous adenoma, and 6.87 (95% CI: 2.61-18.07) for adenoma with high-grade dysplasia. CONCLUSIONS: There is a strong association between results of baseline screening colonoscopy and rate of serious incident lesions during 5.5 years of surveillance. Patients with 1 or 2 tubular adenomas less than 10 mm represent a low-risk group compared with other patients with colon neoplasia.     

Colorectal cancer in patients under close colonoscopic surveillance

BACKGROUND & AIMS: Colonoscopic polypectomy is considered effective for preventing colorectal cancer (CRC), but the incidence of cancer in patients under colonoscopic surveillance has rarely been investigated. We determined the incidence of CRC in patients under colonoscopic surveillance and examined the circumstances and risk factors for CRC and adenoma with high-grade dysplasia. METHODS: Patients were drawn from 3 adenoma chemoprevention trials. All underwent baseline colonoscopy with removal of at least one adenoma and were deemed free of remaining lesions. We identified patients subsequently diagnosed with invasive cancer or adenoma with high-grade dysplasia. The timing, location, and outcome of all cases of cancer and high-grade dysplasia identified are described and risks associated with their development explored. RESULTS: CRC was diagnosed in 19 of the 2915 patients over a mean follow-up of 3.7 years (incidence, 1.74 cancers/1000 person-years). The cancers were located in all regions of the colon; 10 were at or proximal to the hepatic flexure. Although most of the cancers (84%) were of early stage, 2 participants died of CRC. Seven patients were diagnosed with adenoma with high-grade dysplasia during follow-up. Older patients and those with a history of more adenomas were at higher risk of being diagnosed with invasive cancer or adenoma with high-grade dysplasia. CONCLUSIONS: CRC is diagnosed in a clinically important proportion of patients following complete colonoscopy and polypectomy. More precise and representative estimates of CRC incidence and death among patients undergoing surveillance examinations are needed.     

The appropriate use of colonoscopy in the curative management of colorectal cancer

A total of 175 patients who underwent a curative resection for a colonic (n = 130) or a rectal cancer (n = 45) between 1986 and 1992 were entered into a routine clonoscopy program. Colonoscopies were performed 1 year after the operation, and then at 2-year intervals. The findings at colonoscopy, as well as those of preoperative colonoscopy (when performed), were recorded. Eleven anastomotic recurrences were diagnosed at an asymptomatic stage, at a mean follow-up of 14 months. All of them were identified in patients with a stage B or C primary rectosigmoid cancer. Eight patients underwent another potentially curative re-operation. Only perioperative colonoscopy (preoperative colonoscopy; first postoperative colonoscopy in patients for whom the preoperative procedure was incomplete or not performed) allowed diagnosis of second cancers (n = 7) and adenomatous polyps greater than 10 mm (n = 17). Further colonoscopies detected only polyps less than 10 mm. Positive examination rates for successive follow-up colonoscopies were 15, 20 and 23%, respectively; they were significantly higher in patients who had previously had adenomatous polyps than in patients who had not: 30% versus 6% (P<0.025), 46% vs 5% (P<0.005) and 38% vs 11% (P<0.025), respectively. From these data, the following recommendations are made: (1) All colorectal cancer patients should have a total colonoscopy either before (whenever possible) or soon after operation; (2) Based on results of the perioperative colonoscopy, patients: should undergo their first follow-up colonoscopy only 3 yearly (presence of synchronous adenomatous polyps) or 5 yearly (absence of synchronous adenomatous polyps) after resection; (3) In patients with stage B or C primary rectosigmoid cancer, a surveillance of the suture line by rigid proctosigmoidoscopy should be added during the first 2 postoperative years: 6, 15 and 24 months after the operation.     

The role of colonoscopy in screening persons with family history of colorectal cancer

Abstract First-degree relatives of colorectal cancer patients are at increased risk for developing colorectal neoplasms. In order to assess the potentiality of colonoscopy screening in this high-risk population, 213 asymptomatic family members (age range 30-69 years, mean 42.8 years) of those patients with colorectal cancer received colonoscopic examination at Chang-Gung Memorial Hospital from April 1992 to May 1994. Twenty-eight persons with 42 lesions (polyps or cancer) were identified, including 28 adenomas, nine hyperplastic polyps and five adenocarcinomas. The positive detection rate was 9.9% for adenoma and 2.3% for cancer. Colorectal neoplasms afflicted males more frequently than females (16.7 vs 5.7%, P < 0.05) and occurred less frequently in those < 40 years of age (5.5 vs 17.2%, P < 0.05). Forty-two per cent of the detected neoplastic lesions were beyond the reach of 60 cm flexible sigmoidoscopy and 36% of adenomas were < 0.5 cm in size and would be missed if patients were screened by air contrast barium enema. Cost analysis revealed that the charges of both screening colonoscopy and screening flexible sigmoidoscopy/air contrast barium enema were approximate. Colonoscopy also has a high acceptability and safety. It appears appropriate to use colonoscopy, rather than flexible sigmoidoscopy or air contrast barium enema, as an initial screening procedure for persons with a family history of colorectal cancer, especially those > 40 years of age.     

直肠异常隐窝病灶对结肠肿瘤的预警作用

目的 评判内镜下直肠异常隐窝病灶(ACF)与结肠病变及高癌变潜能肿瘤(AN)的关系.方法 接受全结肠镜检查的正常、息肉、腺瘤及癌的患者212例,在退镜时用0.4%靛胭脂对直肠进行染色,根据直肠ACF的数目对患者分级,无ACF者为0级,ACF数目为1～4,5～9,≥10者分别为Ⅰ、Ⅱ、Ⅲ级,统计分析ACF级别与结肠病变(息肉、腺瘤和癌),高癌变潜能肿瘤(≥1 cm,绒毛状、管状绒毛状,高度异型增生或浸润癌)的关系.结果 212例患者中,72例直肠ACF为0级,48例为Ⅰ级,41例为Ⅱ级,51例为Ⅲ级.直肠有ACF(包括Ⅰ、Ⅱ、Ⅲ级)的患者发生结肠病变及结肠高癌变潜能肿瘤的概率较无ACF者明显升高,其OR值(95%CI)分别为22.352(6.716～74.395),7.982(1.838～34.672).结论 直肠ACF对结肠病变及高癌变潜能肿瘤有预示作用.