大肠癌患者一级亲属的电子肠镜与粪便潜血试验的筛查结果分析

Screening colonoscopy and faecal occult blood testing in the first grading kinship of patients with colorectal cancer

目的研究大肠癌先证患者的一级亲属的电子肠镜和粪便潜血试验(faecal occultblood testing,FOBT)筛查的临床意义。方法前瞻性分析大肠癌先证患者的一级亲属186例的电子肠镜和 FOBT 的筛查结果。FOBT 应用试纸免疫法和氨基比林化学法。结果在186例亲属的肠镜检查中阳性病变检出率高达80.1%,其中癌前病变占41.1%,恶性疾病占23.6%。而 FOBT 的检出率只有22.3%,明显低于肠镜的检出率(P<0.001)。大肠息肉、息肉癌变和大肠癌在一级亲属的检出率分别为56.5%、6.5%和17.2%,在对照组分别为25.7%、0.5%和6.5%,两组比较,P 均小于0.001。本组小于40岁的患者占阳性病变的20.1%和恶性病变的17.1%。肠镜检查检出 Dukes A 期大肠癌18例,占56.3%,B 期12例,占37.5%,C 期2例,占6.3%,D 期0例。所有大肠癌患者均可进行根治性手术切除。结论在大肠癌先证患者的一级亲属中进行结肠镜筛查明显优于 FOBT,具有较高的检出率,并可预防大肠癌和早期诊断大肠癌和提高根治手术率。

Objective To investigate the clinical significance of screening with colonoscopy and faecal occult blood testing （FOBT） in the first grading kinship of patients with colorectal cancer. Methods Prospective analysis on the results of screening colonoscopy and FOBT in 186 relatives of colon cancer was done in this study. FOBT was done by testing paper immuno-assay and chemical assay of pyramidom. Results The rate of disease detected by colonoscopy was up to 80. 1% in 186 relatives. Among them, cancer precursor was 41. 1% , and malignant disease, 23.6%. The positive rate of FOBT was 22. 3% , and it was lower than that of colonoscopy （ P 〈 0. 001 ）. The detecting rate of polyps, canceration of polyps and colorectal cancer was 56. 5% , 6. 5% , 17.2% and 25.7% , 0.5% , 6. 5% in relatives and the controls respectively （P 〈 0. 001 ）. In patients under the age of 40, colonoscopy could detect 20. 1% patients with lesions and 17. 1% with malignant diseases. A, B, C, and D stage of colorectal cancer that was detected by colonosco- py was 56. 3% （18/32） , 37.5% （ 12/32）, 6. 3% （2/32） and 0 respectively. All patients with colorectal cancer received radical operation. Conclusion Colonoscopy screening is a better method and has higher detecting rate than FOBT in the first grading kinship of patients with colorectal cancer. It can prevent colorectal cancer, detect the earlier stage cancer and increase the rate of radical operation.