青年慢性便秘患者结肠镜检查的结果分析

The analysis of the results of colonoscopy in young patients with chronic constipation

目的探讨青年慢性便秘患者进行结肠镜检查的必要性。方法收集2003年4月至2014年5月以慢性便秘为唯一主诉在天津医科大学总医院行结肠镜检查的患者，年龄为18～50岁，分析其结肠镜检查结果及病理特征。结果因慢性便秘行结肠镜检查的18～50岁患者共563例，其中18～35岁260例，36～50岁303例。发现病变的有396例（70．3％），未发现任何病变的有167例（29．7％）。45例患者检出息肉病变（其中13例为多发息肉），其中20例为结直肠腺瘤（17例腺瘤位于远端结肠，3例腺瘤位于近端结肠）。在18～35岁年龄组，腺瘤检出3例（3／260，1．2％），其中进展期腺瘤1例（1／260，0．4％）；在36～50岁年龄组，腺瘤检出17例（17／303，5．6％），其中进展期腺瘤4例（4／303，1．3％），另外结直肠癌检出2例（0．7％，2／303）。18～35岁年龄组的便秘患者结直肠肿瘤（包括腺瘤和癌）检出率显著低于36～50岁年龄组[1．2％（3／260）比6．3％（19／303），P=0．002，95％C1：0．05～0．60]。结论18～35岁慢性便秘患者结直肠肿瘤检出率较低，并不推荐过早进行结肠镜检查。

Objective To explore the necessity of colonoscopy in young patients with chronic constipation. Methods Data of patients aged 18-50 underwent colonoscopy at Tianjin Medical University General Hospital with chronic constipation as the sole indication between April 2003 and May 2014 were analyzed. Endoscopic and pathologic reports were analyzed. Results During the study period, a total of 563 patients were included, who were aged 18-50 with chronic constipation as the sole indication, of which 260 patients were aged 18-35, and 303 patients were aged 36-50. No lesion was found during colonoscopy in 167 （ 29.7% ） patients, whereas in other 396 （ 70. 3 % ） patients positive findings were reported, including polyps in 45 patients （of which 13 were with muhiple polyps） , adenomas in 20（ 17 in distal colon, 3 in proximal colon）. In patients aged 18-35, 3 cases of adenomas （3/260, 1.2%） were found, of which 1 patient （ 1/260, 0. 4%） had advanced adenoma. In patients aged 36-50, 17 cases of adenomas （17/303,5.6%） were found, of which 4 （4/303, 1.3%）were advanced ones. Colorectal cancers were found in 2 patients （ 0. 7%, 2/303 ） , both in patients aged 36-50. The detection rate for colorectal neoplasms （ including adenoma and cancer） in patients with chronic constipation aged 18-35 was significantly lower than that in patients aged 36-50[ 1.2%（3/260） VS 6. 3%（19/303） ,P=0. 002,95%CI： 0.05-0. 60]. Conclusion The detection rate for colorectal neoplasms in patients aged 18-35 years with chronic constipation is relatively low, and colonoscopy is not recommended for them.