结肠癌近20年临床特点的变迁分析

The trends in clinical characteristics of colon cancer in last two decades

目的探讨近20年来结肠癌临床特征表现的异同，为临床早期诊断以及肿瘤筛查方案的选择提供一定依据。方法回顾性分析1989-2008年北京协和医院1233例结肠癌住院患者，按时间阶段分为1989—1998年和1999—2008年两组，分别对结肠癌的临床表现、实验室检查、结肠镜检查、病变部位以及临床分期等特点进行分析。结果与1989—1998年相比，近10年来结肠癌的患病率明显升高，女性及老年患者有所增加；便血的患者明显减少（51．8％比31．7％，P〈0．05），腹部包块和出现肠梗阻的患者也呈下降趋势（30．2％比13．6％，P〈0．05）；血红蛋白下降的患者有所减少，但大便潜血的阳性率有所增加（43．6％比61．2％，P〈0．05）；随着癌胚抗原（CEA）检测的普遍开展，其阳性率也明显增加（32．4％比57．9％，P〈0．05）；结肠镜已成为结肠癌诊断的主要手段，早期病变和合并息肉的患者近年来逐渐增多；肿瘤部位1989—1998年以升结肠为主（44．6％），近10年来逐渐以乙状结肠和降结肠（38．7％和22．7％）为主。手术切除是主要治疗方法，与1989—1998年相比，近10年来早期手术病例（DukeA期）明显增加（9．3％比23．8％，P〈0．05）。结论近年来结肠癌的患病率呈上升趋势，女性和老年患者明显增加；临床表现变得更缺乏特异性；随着大便潜血、CEA检测和结肠镜检查手段的提高和完善，早期患者的检出率有所增加；肿瘤部位从以右半结肠为主转变为以左半结肠为主，与西方国家的特点更为接近。

Objective To explore the changing of clinical features of colon cancer within 20 years, in order to help early diagnosis and screening of colon cancer in China. Methods A total of 1233 cases of colon cancer in Peking Union Medical College Hospital during 1989 -2008 were retrospectively studied. All patients were divided into two groups according to the date of onset （ 1989 - 1998 and 1999 - 2008 ）, the demographic features, clinical manifestations, laboratory examination, colonscopy characteristics and pathological stage were analyzed. Results Comparing with 1989 - 1998, in recently 10 years, the morbidity of colon cancer increased, more female and old patients appeared; hematochezia significant less （51.8% vs 31.7% ,P 〈 0. 05 ） ; abdominal mass and following ileus also decreased （ 30. 2% vs 13.6% , P 〈0. 05 ） ; patients with low of Hb decreased, the positive of stool occult blood increased from 43.6% to 61.2% （P 〈 0. 05 ） , According with the more patients who detected serum CEA, the positive rate significant increased （32.4% vs 57.9% ,P 〈0. 05） . Colonscopy became the mainly method for diagnosis, more and more early stage lesion and polyps were detected. The location of tumor from ascending colon in 1989 - 1998 （44. 6% ） shift to sigmoid colon （38.7%） and descending colon （22. 7% ） up to now. Operation was the first choice of treatment, the early stage （Duke A） patients significant increased （9. 3% vs 23.8% ,P 〈 0. 05 ）. Conclusions In the recently 10 years, the morbidity of colon cancer obviously increased, the age was become elder and female patients were increased. The clinical manifestation became more nonspecific. According with the improvement of stool occult blood, serum CEA and colonscopy detective method and wild spread using, more and more early stage patients were diagnosed. The location of tumor shift from right side to left side, and coincidence with west countries gradually.