DYSPLASIA AND CANCER COMPLICATING STRICTURES IN ULCERATIVE-COLITIS
DYSPLASIA AND CANCER COMPLICATING STRICTURES IN ULCERATIVE-COLITIS
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DOI：
10.1007/bf01537413
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发表时间：
1990-03-01
影响因子：
3.1
通讯作者：
HANAUER, SB
中科院分区：
文献类型：
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作者：
LASHNER, BA;TURNER, BC;HANAUER, SB
先前的研究发现溃疡性结肠炎患者结肠狭窄中异型增生和癌症的患病率差异很大。因此，治疗建议相互矛盾。为了更好地评估患病率，我们回顾了所有27例溃疡性结肠炎并发狭窄患者的临床和病理结果，这些患者被纳入我们的炎症性肠病登记处。真正的狭窄定义为气钡灌肠或结肠镜检查发现的持续性局限性结肠狭窄。经过仔细审查，发现27例患者中有12例出现短暂性结肠痉挛，而不是狭窄，因此被排除。其余15例真正狭窄的患者占登记研究中所有溃疡性结肠炎患者的3.2%。在13.3 .+-处鉴定出细菌。9.9在溃疡性结肠炎诊断后数年。11例患者有多处狭窄，主要位于左结肠。在15名患者中，11名有异型增生，2名有结肠镜活检发现的癌症。最终，6名患者在结肠镜检查或结肠切除术中发现了癌症（3名改良Dukes 'A期，1名B期和2名D期）。所有癌症均位于狭窄部位。这些发现表明，溃疡性结肠炎的真正的结肠狭窄经常与异型增生和癌症有关，这可以通过结肠镜活检来诊断。狭窄应被认为是癌症的一个强有力的危险因素，需要加强结肠镜监测。如果发现异型增生，或者狭窄处不能充分活检，应考虑全结肠切除术。
Previous studies have found a widely variable prevalence of dysplasia and cancer in colonic strictures in patients with ulcerative colitis. Consequently, therapeutic recommendations are conflicting. To better assess the prevalence, we reviewed the clinical and pathological findings in all 27 patients with ulcerative colitis complicated by stricture who were entered into our Inflammatory Bowel Disease Registry. A true stricture was defined as a persistant localized narrowing of the colon found on air-contrast barium enema or on colonoscopy. Upon careful review, 12 of 27 patients were found to have transient colonic spasm, not a stricture, and were excluded. The remaining 15 patients with true strictures represented a 3.2% of all ulcerative colitis patients in the registry. Strictures were identified at 13.3 .+-. 9.9 years following the diagnosis of ulcerative colitis. Eleven patients had multiple strictures that were principally located in the left colon. Of the 15 patients, 11 had dysplasia and two had cancer found on colonoscopic biopsy. Ultimately, six patients had carcinoma found at colonoscopy or colectomy (three modified Dukes'' stage A, one stage B, and two stage D). All cancers were at the site of a stricture. These findings indicate that a true colonic stricture in ulcerative colitis is frequently associated with dysplasia and cancer, which can be diagnosed with colonoscopic biopsy. A stricture should be considered a strong risk factor for cancer, requiring intensive colonoscopic surveillance. If dysplasia is discovered, or if the stricture cannot be adequately biopsied, consideration should be given to total colectomy.