大肠癌术后患者结肠镜随访检查的意义

Colonoscopy surveillance in colorectal cancer after surgery

目的通过大肠镜检查在临床的广泛应用，防止和降低多原发大肠癌的发生。方法分析1986年6月至2007年6月大肠癌外科术后进行无症状定期结肠镜随访2762例患者的资料，随访方法为术后3～6个月内首次肠镜检查，以后每年1次，连续3年。并与1981年9月至1986年5月大肠癌术后有症状者结肠镜复查的218例资料进行对比。结果2762例中发现多原发癌48例，其中同时多原发癌39例（1．4％），异时多原发癌9例（0．3％）；TNM分类Ⅰ期癌6例，Ⅱ期癌31例，Ⅲ期癌11例。发现腺瘤583例（21．1％），病理检查证实17例（3．2％）为浸润性早期癌，58例（9．9％）为高级别上皮内瘤变。218例有症状检查者共发现多原发癌27例（12．4％），明确Ⅰ期癌4例，Ⅱ期癌6例，Ⅲ期癌16例。发现腺瘤29例（13．3％）。结论无症状定期结肠镜随访检查发现多原发癌明显低于有症状者，发现的早期癌、腺瘤比例高，说明无症状定期检查，能防止和降低多原发大肠癌的发生。

Objective To evaluate the colonoscopy surveillance in colorectal cancer patients after surgical removal of the tumor. Methods From June 1986 to June 2007, 2762 asymptomatic patients who had underwent operation for colorectal cancer were put into colonoscopy surveillance. They had the first examination 3-6 months after the operation, and were re-examined once a year thereafter for 3 years. The follow-up findings were compared with those from the 218 symptomatic patients who had colorectal cancer surgery from September 1981 to May 1986. Results In 2762 asymptomatie patients, 48 cases of multiple primary cancer were detected, in which 39 cases （ 1.4% ） were found at one examination and 9 cases （0. 3% ） at different examination. The TNM staging of these lesions included stage Ⅰ in 6, stage Ⅱ in 31 and stage Ⅲ in 11. During the surveillance, 583 cases （21. 1% ） of adenoma were detected and endoscopieally resected, in which 17 （3.2%） were invasive early cancer and 58 （9. 9% ） were high grade dysplasia. In 218 patients with symptoms, 29 cases （ 13.3% ） of adenoma and 27 cases （ 12.4% ） of cancer were detected, including 4 cases of stage Ⅰ cancer, 6 of stage Ⅱ and 16 of stage m. Conclusion Colonoscopy surveillance in colorectal cancer patients after surgery is important in finding precancerous lesion and early stage cancer, and is recommended in all patients.