大肠癌临床表现的多样性及其误诊

The Variable Clinical Manifestations of Colorectal Cancer and its Misdiagnosis

本文报道1970年1月至1995年12月在北京协和医院经手术病理确诊的791例大肠癌,其中结肠癌396例,直肠癌395例,年龄20～85岁,平均54.4岁。分析结果提示:(1)本组大肠癌手术病例逐年增多。(2)Duke A、B期占36％,C、D期平均误诊时间比A、B期长3个月。(3)以粘液血便,便鲜血、腹痛伴包块,首发贫血及间断发烧为临床重要表现,分别占大肠癌的15.3％、10.2％、7.6％、5.4％及2.0％。这些病人一度被误诊为菌痢、内痔、急慢性肠梗阻、贫血或肠结核等。(4)7cm以下的直畅癌占42.2％,其有75.1％的患者却未做肛门指诊,是误诊的重要原因之一。(5)粪潜血试验阳性率为84％,可作为筛查的一种手段。

Background/Aims: To review the causes of misdiagnosis of colorectal cancer, the anthors summarized their experiences aiming at diminution of the rate of misdiagnosis. Subjects: 791 cases (age: 20-85yrs, mean 54.4) of colorectal cancer operated and histology-proven at the Peking Union Medical College Hospital from Jan. 1970 to Dec. 1995. The ratio of colonic and rectal cancer as well as male to female was 1:1. Results: (1) The operated cases increased with time. (2) Staging: 36% of the patients were Duke A and B. The period of misdiagnosis of Duke C and D was 3 months longer than that of Duke A and B. (3) The main symptoms in this group were: mucus and blood in stool (15.3%), rectal bleeding (10.2%), abdominal pain associated with palpable mass (7.6%), anaemia as the first symptom (5.4%) and intermittent fever (2.0%). Most commonly they were misdiagnosed as: bacillary dysentery, internal hemorrhoid, intestinal obstruction, iron deficiency anemia and intestinal tuberculosis etc. (4) 42% of the rectal were within 7cm above the anus, unfortunately, 75% of them had not undergone digital rectal examination. (5) Fecal occult blood test had a positive rate of 84% and 3 consecutive tests yielded a positive rate of 100%, much higher than a single test (positive rate 20%). Conclusions: Patients with the above symptoms should be suspected of colorectal cancer. Fecal occult blood test and digital rectal examination are of prime importance in the diagnosis of colorectal cancer.