Colonoscopic evaluation of minimal rectal bleeding in average-risk patients for colorectal cancer.
Colonoscopic evaluation of minimal rectal bleeding in average-risk patients for colorectal cancer.
复制标题
结肠镜评估结直肠癌平均风险患者的最小直肠出血。
DOI：
10.3748/wjg.14.6536
复制
发表时间：
2008
影响因子：
4.3
通讯作者：
Ali Ali Asgari
中科院分区：
文献类型：
--
作者：
S. Nikpour;Ali Ali Asgari
目标
目的：评估每直肠微小大红色出血(BRBPR)患者中临床显著病变的发生率。
方法
连续的门诊患者在德黑兰的洛格曼·哈基姆医院接受结肠镜检查。微量BRBPR被定义为擦拭后或马桶中有少量红色血液。有下列警报体征的患者被排除在外：有结直肠肿瘤或炎症性肠病(IBD)的个人病史，有结直肠肿瘤的一级家族史，有排便习惯改变的病史，最近体重显著减轻，以及存在缺铁性贫血。肿瘤性息肉、结直肠癌和IBD被定义为重要病变。
结果
共研究了402例患者(女性183例，男性219例，年龄43.6+/-15.7岁)。最常见的病变是内脏(54.2%)、肛裂(14.2%)和溃疡性结肠炎(14.2%)，结肠镜检查正常的占8.0%。121例(30.1%)有明显病变，其中腺癌26例(6.5%)，腺瘤性息肉30例(7.5%)。几乎所有有明显病变的患者在远端结肠至少有一个病变；在2例内痔患者中，在近端结肠发现一例腺癌和一例腺瘤性息肉。
结论
灵活的乙状结肠镜检查似乎足以评估BRBPR最小的平均风险患者。硬性乙状结肠镜检查可作为40岁以下患者的一种选择，在前者无法使用的情况下。在50岁以上的患者中，选择结肠镜检查而不是柔性乙状结肠镜检查应该个体化。
AIM
To assess the prevalence of clinically significant lesions in patients with minimal bright red bleeding per rectum (BRBPR).
METHODS
Consecutive outpatients prospectively underwent colonoscopy at Loghman Hakim Hospital, Tehran. Minimal BRBPR was defined as small amounts of red blood after wiping or in the toilet bowl. Patients with the following alarm signs were excluded: Positive personal history of colorectal neoplasms or inflammatory bowel disease (IBD), positive first degree family history of colorectal neoplasms, history of altered bowel habits, recent significant weight loss, and presence of iron deficiency anemia. Neoplastic polyps, colorectal carcinoma, and IBD were defined as significant lesions.
RESULTS
A total of 402 patients (183 female and 219 male, aged 43.6 +/- 15.7 years) were studied. Hemorrhoids (54.2%), anal fissures (14.2%) and ulcerative colitis (14.2%) were the most common lesions and colonoscopy was normal in 8.0%. Significant lesions were found in 121 (30.1%) patients, including 26 patients (6.5%) with adenocarcinoma and 30 (7.5%) with adenomatous polyps. Almost all patients with significant lesions had at least one lesion in the distal colon; an adenocarcinoma and an adenomatous polyp in the proximal colon were found in 2 patients with hemorrhoids.
CONCLUSION
Flexible sigmoidoscopy appears to be sufficient for the evaluation of average risk patients with minimal BRBPR. Rigid sigmoidoscopy may be used as an alternative in patients less than 40 years of age in settings where the former is not available. The choice of colonoscopy over flexible sigmoidoscopy in patients aged over 50 years should be individualized.