Clinical Experience with Flexible Sigmoidoscopy in Asymptomatic and Symptomatic Patients
Clinical Experience with Flexible Sigmoidoscopy in Asymptomatic and Symptomatic Patients
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无症状和有症状患者使用柔性乙状结肠镜检查的临床经验
DOI：
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发表时间：
1980
期刊：
影响因子：
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通讯作者：
R. McCallum
中科院分区：
文献类型：
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作者：
C. Meyer;W. McBride;R. Goldblatt;J. Borak;P. Marignani;H. Black;R. McCallum
本研究的目的是评价在40岁以上的无症状患者中作为常规程序进行的软式乙状结肠镜检查的诊断率，这些患者被转诊进行全面的体格检查。该项目的初步结果与408例具有提示结直肠疾病症状和体征的患者的诊断率一起呈现，这些患者的年龄（56.6岁对56.5岁）和性别分布（79%为男性）与无症状人群相似，并且接受了乙状结肠镜检查作为其评估的指示部分。在122例无症状患者中，该手术检查的平均距离为50.8 cm，100%的患者器械推进超过20 cm的最佳硬质乙状结肠镜检查距离。在无症状组中，16例患者（13.1%）发现腺瘤性和增生性息肉，与有症状人群（15.4%）的比例相似。腺瘤性息肉在无症状受试者中的诊断率为7.4%，在有症状组中的诊断率为9.1%。结肠癌在无症状患者中的诊断率为0.8%，在有症状患者中的诊断率为3.2%（p < 0.05）。在无症状患者中检测到的肿瘤性息肉的77%和在有症状组中检测到的肿瘤性息肉的60%超过肛门20 cm。憩室病的诊断率相似，无症状组为13.1%，有症状组为10.0%。未发生并发症，手术耐受性良好，无需镇痛。结论是：（1）在40岁以上的无症状人群中，作为常规检查的柔性乙状结肠镜检查导致刚性直肠乙状结肠镜检查不可能的诊断率，并且其接近在相似年龄的有症状人群中观察到的诊断率;（2）对于接受过本程序培训的内科医生，可弯曲乙状结肠镜检查在检测结直肠病变中具有未来的作用，并可作为无症状患者的癌前病变和结直肠癌的间隔筛查检查。和有症状的患者。图像FIG. 1
The purpose of this study was to evaluate the diagnostic yield of flexible sigmoidoscopy when performed as a routine procedure in asymptomatic patients over the age of 40 being referred for a complete physical examination. The preliminary results of this ongoing program are presented together with the diagnostic yield in 408 patients with symptoms and signs suggestive of colorectal disease who were of similar age (56.6 vs. 56.5 years) and sex distribution (79 percent male) to the asymptomatic population, and who underwent flexible sigmoidoscopy as an indicated part of their evaluation. In the 122 asymptomatic patients, the mean distance examined by the procedure was 50.8 cm with the instrument being advanced beyond the optimal rigid sigmoidoscopy distance of 20 cm in 100 percent of patients. Adenomatous and hyperplastic polyps were identified in 16 patients, 13.1 percent, in the asymptomatic group, a similar percentage to the symptomatic population, 15.4 percent. Adenomatous polyps were diagnosed in 7.4 percent of the asymptomatic subjects and 9.1 percent of the symptomatic group. Colonic cancer was diagnosed in 0.8 percent of asymptomatic patients vs. 3.2 percent of the symptomatic group (p < 0.05). Seventy-seven percent of the neoplastic polyps detected in the asymptomatic patients and 60 percent in the symptomatic group were beyond 20 cm from the anus. Diverticulosis was diagnosed in a similar percentage of patients, 13.1 percent in the asymptomatic and 10.0 percent in the symptomatic group. No complications were encountered and the procedure was well tolerated without analgesia. It is concluded that: (1) in an asymptomatic population over the age of 40, flexible sigmoidoscopy, as a routine examination, results in a diagnostic yield not possible with rigid proctosigmoidoscopy and which approaches that observed in a symptomatic population of similar age; (2) for the internist trained in this procedure, flexible sigmoidoscopy has a future role in the detection of colorectal lesions and as an interval screening examination for premalignant lesions and colorectal cancer in asymptomatic and symptomatic patients. ImagesFIG. 1