结肠镜提示大肠癌致不全梗阻病例术后肠镜复诊情况分析  

Follow-up of colonoscopy after curative surgical resection for colorectal cancer with incomplete obstruction

作　　者：杨栋[1] 李梦 陶克[1] 陈更[1] 汤赢 徐红[1] Yang Dong;Li Meng;Tao Ke;Chen Geng;Tang Ying;Xu Hong(Department of Gastroenterology,the First Hospital of Jilin University,Changchun 130021,China;Gastrointestinal Surgery,the First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院胃肠内科·内镜中心,长春130021 [2]吉林大学第一医院胃结直肠外科,长春130021

出　　处：《中华结直肠疾病电子杂志》2021年第1期56-60,共5页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：吉林省卫生服务能力提升项目(No.2017F005)。

摘　　要：目的对术前行结肠镜检查提示因大肠癌致不全梗阻的病例进行汇总分析,从而更好地指导该类患者术后肠镜复查。方法汇总2009年4月至2019年4月在吉林大学第一医院胃肠内科·内镜中心行肠镜检查并提示因大肠癌致不全梗阻的208例病例,研究纳入患者的基本资料,并按肿瘤位置进行左(L组)右(R组)半结肠分组,对比分析术前肠镜结果、术后病理分期、术后肠镜复诊结果等资料。结果纳入的208例病例中R组66例,L组142例。术前肠镜检查肠道清洁程度对比,L组较R组更佳(χ^(2)=52.905,P<0.01)。共77例病例进行术后肠镜复诊,仅占比37.0%,中位首次随访时间为8.0(6.0~12.0)个月,L组复查病例中新发现原发大肠癌1例。两组新发现息肉病例比例差异无统计学意义(53.8%vs.56.9%,χ^(2)=0.064;P=0.801),对比息肉分布于吻合口肛侧病例比例,R组较L组明显增多,差异存在统计学意义(53.8%vs.7.8%,χ^(2)=20.346;P<0.01)。中低位直肠癌病例局部复发率达11.8%,较其他部分大肠癌高,经比较差异存在统计学意义(χ^(2)=7.247,P<0.05)。结论对术前行结肠镜检查提示因大肠癌致不全梗阻的病例,应提高术后早期肠镜复查意识,右半结肠术后肠镜复查注意漏诊息肉,左半结肠术后肠镜复查需注意排除合并多原发癌可能,中低位直肠癌保肛术后尤其需要注意吻合口局部复发情况,以期改善此类患者生存预后。Objective To study the cases of colorectal cancer with incomplete obstruction which was revealed by preoperative colonoscopy.Methods All included cases of colorectal cancer with incomplete obstruction which was revealed by preoperative colonoscopy were studied retrospectively between April 2009 and April 2019 in the First Hospital of Jilin University.According to the location of the tumors,all cases were divided into two groups:right-sided group(group R)and left-sided group(group L),and the relevant clinical and pathological data were compared and analyzed.Results Totally 208 cases were included,with group R and group L including 66 and 142 cases respectively.For the quality of colon cleansing of preoperative colonoscopy,group L was better than that of group R(χ^(2)=52.905,P<0.01).A total of 77 cases were reexamined by colonoscopy,accounting for only 37.0%,and the median follow-up time was 8.0(6.0~12.0)months.In group L,one case of primary colorectal cancer was found.There was no significant difference between the two groups in terms of the proportion of newly discovered polyps(53.8%vs.56.9%,χ^(2)=0.064;P=0.801).For the distribution of polyps on the anal side of the anastomosis,the incidence of cases in group R was significantly higher than that in group L(53.8%vs.7.8%,χ^(2)=20.346;P<0.01).The local recurrence rate of middle and low rectal cancer was 11.8%,which was higher than that of other colorectal cancer(χ^(2)=7.247,P<0.05).Conclusion For patients suffering from colorectal cancer with incomplete obstruction which was revealed by preoperative colonoscopy, early post-operative colonoscopy should beoffered. Missed polyps should be noted in the follow-up of colonoscopy after right hemicolectomy. For theleft-sided colorectal cancer, the possibility of multiple primary cancers should be excluded. Especially, for themiddle and low rectal cancer, local recurrence of the anastomosis should be paid attention to after anuspreserving operation, so as to improve the survival of such patients.

关 键 词：结肠镜 结直肠肿瘤 不全梗阻 随访 

分 类 号：R735.34[医药卫生—肿瘤]