老年人大肠息肉与大肠癌

THE LARGE BOWEL POLYPS AND CARCINOMAS IN ELDERLY PATIENTS

为了解老年人大肠息肉和大肠癌的临床特点，更好地预防老年人大肠肿瘤的发生和早期诊断大肠癌，对２４８例老年人大肠息肉和大肠癌的临床及病理作一回顾性分析。结果老年人大肠息肉和大肠癌的检出率分别为３３．３％和２３．３％，并有以下特点：（１）大肠息肉和大肠癌是老年人便血的主要原因，炎性息肉、腺瘤性息肉及大肠癌三者的便血率依次增高；（２）息肉检出率显著高于普通人群息肉检出率，且腺瘤性息肉占７３．８％；（３）多发性息肉比例较高，并以腺瘤性息肉为主，占８０．７％，且多发生于不同的肠段；（４）老年人大肠癌低恶性程度者多；（５）大肠腺瘤性息肉常与大肠癌并存，二者多发生于不同肠段。因此，我们认为便血是老年人大肠镜检查的有力指征；大肠镜检查时不应满足于远端大肠病变的诊断，应尽可能检查全大肠；对老年人大肠息肉，尤其是多发性息肉及直径大于１．０ｃｍ者应积极切除。

In order to master the clinical characteristics and occurrence regularities of the colorectal polyps and carcinomas in the elderly patients , and prevent the occurrence of large bowel tumors and diagnose the early colorectal carcinomas , we have reviewed the clinical presentations and pathological patterns of the 248 cases of large bowel polyps and carcinomas in the elderly patients discovered by colonoscopy from December 1 976 to December 1 99 5 . The results indicated that the disease frequencies of polyps and carcinomas were 33. 3% and 23. 3% respectively. The characteristics of colorectal polyps and carcinomas in elderly patients were as follow : 1 )The most common diseases causing large bowel bleeding were colorectal polyps and carcinomas . The frequency of bleeding due to adenomatous polyps was higher than that of inflamatory polyps but lower than that of carcinomas. Discharging bloody stool and weight lose were the late presentation of patients with colorectal carcinomas. 2 ) The incidence of colorectal polypst in ederly patients was significantly higher than that in the younger patients . and 73. 8% of the polyps were adenomatous in nature. 3)The incidence of multiple polyps was 39. 0% and of which adeno- matous was 80. 7% . Usually ,the multiple polyps were discovered in different segments. 4)In elrlerly pa- tients , most colorectal carcinomas were less malignant. 5 )Carcinomas and adennmatous polyps may co- exist in different bowel segments (accounting for 95. 2 %). Our results indicated that elderly people with bloody stool or occult blood stool ,changed habit of bowel movement or unkown anaemia should undergo the colonoscopic examinations on that the large bowel polyps and carcinomas could be diagnosed earlier. ln colonoscopic examination , we could not be satisfied with the discovery of the lesion in the distal col- orectal segments. We should exmine the whole large bowel and cut the polyps , especialy the multiple polyps or larger than 1 . 0 centimeter in diameter