青年大肠癌临床特点及误诊原因分析

Clinical features and cause of misdiagnosis for colorectal cancer in young people

目的探讨青年大肠癌的临床特点及误诊原因。方法回顾分析本院2000年1月至2008年1月确诊的青年大肠癌112例和老年大肠癌542的临床资料,分析两组患者的发病因素、临床特征、病理特点、预后及误诊原因。结果①青年组中有家族史者占18.8%,明显高于老年组4.4%(P(0.01);青年组中有不良生活方式(吸烟、饮酒、饮食不规律)占58.0%,明显高于老年组25.3%(P(0.01);②两组患者均以便血和排便习惯为主要临床表现,青年组便血、腹痛发生率均明显高于老年组(P(0.01);两组患者病变部位均以直肠为主,青年组右半结肠癌发生率明显高于老年组(P(0.01)。③青年组低分化、未分化腺癌、粘液腺癌、印戒细胞癌占70.5%,明显高于老年组33.9%(P(0.01);青年组Dukes分期C、D期占76.8%,明显高于老年组49.1%(P(0.01)。④青年组误诊率65.2%明显高于老年组24.4%(P(0.01);青年组1、3、5年生存率分别为58.7%、20.2%和10.6%,明显低于老年组的90.2%、55.3%和34.9%(P均(0.01)。⑤误诊原因:客观上青年人耐受力强,早期症状不典型,易与其他良性疾病相混淆;主观上医师对青年大肠癌重视不够,未做直肠指诊、大便常规及隐血等常规检查。结论青年大肠癌分化程度低、恶性程度高、转移早、发展快,易贻误诊断,预后不良,故加深对青年大肠癌的认识,提高早期诊疗水平,对社会和家庭都有重要意义。

Objective To study the clinical features and cause of misdiagnosis on colorectal cancer（CRC） in young people. Methods A retrospective review was made in 112 CRC young patients and 542 aged patients treated in our hospital from January 2000 to January 2008. Their etiological factors, clinical features, pathological features , prognosis and cause of misdiagnosis were compared. Results ①The rate of family CRC history was 18.8% in young group, which was higher significantly than the rate （4. 4% ） of the aged group（ P 〈 0.01 ）. The ratio with unhealthy lifestyle （smoking, drinking,irregular diet）in young group （58. 0% ）was obvisouly higher than that in aged group （25.3%） （ P 〈 0.01 ）. ②The clinical manifestation was mostly blood stool or change of bowel evacuation habit in both groups. The incidence of blood stool and abdominal pain in young group were higher than in aged group（ P 〈 0.01 ） ;rectum was the most frequent position of CRC in both groups. The incidence of right colon cancer in young group was higher than in aged group（ P 〈 0.01 ）. ③There were 70.5% patients of ring cell cancer and lower differentiation in the young group,which was higher than the rate（33.9% ） in the aged group（ P 〈 0.01 ） ;there were 76.8% patients of Dukes C and D in young group,which was higher than the rate（ 49.1% ） in aged group（ P 〈 0.01 ）. ④The misdiagnosis rate was 65.2% in young group,which was higher than the rate （24.4%） in aged group（ P 〈 0.01 ）. The overall 1 - year,3 -year,5 -year survival rates of young group（58.7% ,20.2% , 10.6% ） were significantly lower than the rates of aged group（90.2% ,55.3% ,34. 9% ） （all P 〈 0.01 ）. ⑤Cause of misdiagnosis：objeetively, CRC in young people had little typical symptom in early stage and were difficult in differential diagnosis from other diseases;subjectively, surgeons pay little attention to it and didn＇t prescribe some routine examination （rectal touch, the routine examination and occult blood of stool） for the young patients. Conclusion Compared with old group,young group is mainly of intermediate or advanced stage and has a higher misdiagnosis rate and poorer prognosis. Therefore, the early diagnosis of CRC in young patients should be enforced.