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中华结直肠疾病电子杂志 ›› 2021, Vol. 10 ›› Issue (01) : 56 -60. doi: 10.3877/cma.j.issn.2095-3224.2021.01.008

所属专题: 经典病例 文献

论著

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
杨栋1, 李梦2, 陶克1, 陈更1, 汤赢1, 徐红1,()   
  1. 1. 130021 长春,吉林大学第一医院胃肠内科·内镜中心
    2. 130021 长春,吉林大学第一医院胃结直肠外科
  • 收稿日期:2020-05-29 出版日期:2021-02-25
  • 通信作者: 徐红
  • 基金资助:
    吉林省卫生服务能力提升项目(2017F005)

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

Dong Yang1, Meng Li2, Ke Tao1, Geng Chen1, Ying Tang1, Hong Xu1,()   

  1. 1. Department of Gastroenterology, the First Hospital of Jilin University, Changchun 130021, China
    2. Gastrointestinal Surgery, the First Hospital of Jilin University, Changchun 130021, China
  • Received:2020-05-29 Published:2021-02-25
  • Corresponding author: Hong Xu
引用本文:

杨栋, 李梦, 陶克, 陈更, 汤赢, 徐红. 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[J]. 中华结直肠疾病电子杂志, 2021, 10(01): 56-60.

Dong Yang, Meng Li, Ke Tao, Geng Chen, Ying Tang, Hong Xu. Follow-up of colonoscopy after curative surgical resection for colorectal cancer with incomplete obstruction[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2021, 10(01): 56-60.

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(χ2=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%,χ2=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%,χ2=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(χ2=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 (χ2=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%, χ2=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%, χ2=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 (χ2=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 be offered. Missed polyps should be noted in the follow-up of colonoscopy after right hemicolectomy. For the left-sided colorectal cancer, the possibility of multiple primary cancers should be excluded. Especially, for the middle and low rectal cancer, local recurrence of the anastomosis should be paid attention to after anus preserving operation, so as to improve the survival of such patients.

表1 两组肠道清洁程度对比(例)
表2 术后病理分期
表3 术后肠镜随访结果
图1 左右半结肠癌患者术后生存率对比
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