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直肠出血年轻患者行全结肠镜检查是否有必要?

发布日期:2014-1-29 12:40:15 文章来源:Endoscopy 作者次数:1262
    直肠出血年轻患者行全结肠镜检查是否有必要?
     
    A.  B.  Khalid1, S.  Majid1, M.  Salih1, F.  Hashmat1, W.  Jafri1
    1巴基斯坦卡拉奇的阿迦汗大学医院内科部消化科
    背景与研究目的:
        人们对直肠出血(FBPR)年轻患者评价指导方针和措施存有异议。本研究的目的就是来确定直肠出血(FBPR)年轻患者內镜下直肠病变发生的频率和部位,由此来确定这些年轻患者是否有必要进行全结肠镜检查。
     
    方法:
        本研究纳入年龄在18-50岁的系列患者,征得他们同意后,安排他们于2007年5月至2009年10月期间,在阿迦汗大学医院接受直肠出血(FBPR)的全结肠镜检查。直肠出血(FBPR)就是指不管是否大便,直肠都有新鲜血液流出,和/或能在马桶里看到血迹;直肠病变常发生于脾曲近端或远端;且本研究不包括以下患者:有大肠癌阳性家族史的,需输血的出血者,有出血素质的,或者有缺铁性贫血的。
     
    结果:
        总共379例患者符合纳入标准,其中248例(65.4 %)年龄不到40岁,131例(34.6 %)在40-50岁之间。对这些患者进行內镜检查,结果发现:本研究中所有患者的平均血红蛋白为12.93 ± 1.78 g/dL;在年龄小于40岁患者中,发现7处(2.8 %)腺瘤性息肉和恶性病变,这些息肉和病变都位于远端结肠内;同时在40-50岁间的患者中,发现10处 (7.6 %) )腺瘤性息肉和恶性病变,其中有一处位于近端结肠内。单因素分析发现:恶性和腺瘤性病变在40-50岁患者人群中发生显著(P = 0.031;优势比(OR)为2.84;95 %置信区间(CI)为1.05 - 7.65)。
     
    结论:
        因为年龄不到40岁的直肠出血(FBPR)患者內镜下直肠病变多数发生于远端结肠内,所以这些患者要是没有其他重大病症的话,软乙状结肠镜检查术看起来是一种合理的评价手段。
     
     
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    Is full colonoscopic examination necessary in young patients with fresh bleeding per rectum?
     
    A.     B.  Khalid1, S.  Majid1, M.  Salih1, F.  Hashmat1, W.  Jafri1
    1Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
    Background and study aims: Guidelines and practices differ regarding evaluation of young patients with fresh bleeding per rectum (FBPR). The aim of this study was to determine the frequency and site of endoscopic lesions in young patients with FBPR, and to thereby determine whether full colonoscopic examination is necessary in these patients.
    Methods: Consecutive patients aged 18 - 50 years who were scheduled to undergo full colonoscopy for FBPR at Aga Khan University Hospital between May 2007 and October 2009 were enrolled in the study after giving informed consent. FBPR was defined as the passing of fresh blood per rectum with or without stools and/or noticing blood in the toilet bowl. Lesions were characterized as proximal or distal to the splenic flexure. Patients with positive family history of colorectal cancer, bleeding requiring blood transfusion, bleeding diathesis, or iron deficiency anemia were excluded.
    Results: A total of 379 patients met the inclusion criteria and were analyzed. Of these, 248 patients (65.4 %) were under 40 years of age and 131 (34.6 %) were aged 40 - 50 years. Mean hemoglobin was 12.93 ± 1.78 g/dL. In patients < 40 years, seven (2.8 %) adenomatous polyps and malignant lesions were found, all of which were located in the distal colon. In patients aged 40 - 50 years, 10 (7.6 %) adenomatous polyps and malignant lesions were detected, one of which was located in the proximal colon. On univariate analysis, malignant and adenomatous lesions were
    Conclusion: Endoscopic lesions in patients younger than 40 years with FBPR are found mostly in the distal colon and hence flexible sigmoidoscopy seems to be a reasonable evaluation tool in young patients with no other alarm symptoms.
     
     
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