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在溃疡性结肠炎患者中监测结肠直肠癌的有效性:一项源于特定地区患者队列的26年经验

世界核心医学期刊文摘（胃肠病学分册） 2006年第2期2卷 61-62页

作者： Lindberg J. Stenling R. Palmqvist R. Rutegrd J. 李宏宇 Department of Surgery rnskldsvik Hospital SE- 891 89 rnskldsvik Sweden Dr.

Objective. Patients with ulcerative colitis (UC) have an increased risk of developing colorectal cancer (CRC). The current procedure to diminish this risk is colonoscopic surveillance and histopathological evaluation of biopsy specimens. This method is not unquestioned and is undergoing continuous evaluation. The present study is a major update of an earlier reported investigation from an ongoing surveillance programme. Material and methods. In 1977 a colonoscopic surveillance programme comprising all patients with UC from a defined area was started in ? rnsk ldsvik. Three principal investigators performed regular colonoscopy with mucosal sampling for histopathological evaluation. Some 211 patients were studied from 1977 to 2002. At the end of the study period, 90 patients, including those operated on, had total colitis (TC) for more than 10 years, 74 patients had left the study, 31 after panproctocolectomy (PPC), 6 owing to advanced biological age, 1 because of intercurrent disease, 23 patients had moved out of the area and 13 patients were excluded because of poor compliance. In all, 928 colonoscopies were performed. Results. It was found that 135 patients had radiologically or morphologically defined TC and 69 patients had left-sided colitis (LC). Nine CRCs were diagnosed in 8 patients, one of whom died of CRC, while another two were included in the programme with a diagnosis of CRC. Morphological alterations classified as dysplasia or indefinite for dysplasia (ID) were found in 52 patients, 5 of whom were later found to have CRC. In total, 49 patients were operated on; in 15 of these patients the indication for surgery was dysplasia or CRC. Eighteen of the patients were operated on for different kinds of colonic resections and in 31 patients a PPC was performed. Conclusions. Colonoscopic surveillance is an effective method in preventing death from CRC among patients with UC. A conservative approach to surgery seems to be justified. The burden of the surveillanc

关键词：溃疡性结肠炎结肠直肠癌特定地区结肠镜检查全结肠炎黏膜标本生物学年龄全结肠切除术发育异

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复发性移行细胞胆囊癌转移至胃肠道的超声内镜影像表现

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世界核心医学期刊文摘（胃肠病学分册） 2005年第7期1卷 25-25页

作者： Yusuf T.E. Levy M.J. Wiersema M.J. 朱国栋 Developmental Endoscopy Unit Div. of Gastroenterol. and Hepatol. Mayo Clinic 200 First St. SW Rochester MN 55905United States Dr.

Background: Recurrent transitional cell bladder cancer (TCBC) can metastasize to the GI tract albeit uncommonly. This is the first report of the EUS appearan ce of metastatic TCBC to the GI tract. In addition to describing the EUS feature s of recurrent metastatic TCBC, this study determined the number of patients ref erred for evaluation of a primary GI luminal cancer in which EUS instead establi shed the diagnosis of metastatic recurrent TCBC. Methods: Patients referred from July 2000 through April 2004 for EUS evaluation of a suspected primary GI lumin al cancer were retrospectively reviewed. For patients with an established diagno sis of recurrent metastatic TCBC, EUS images were retrospectively reviewed to id entify characteristic features. Results: Of 2216 patients undergoing EUS to eval uate a suspected primary GI luminal cancer, 3 men (0.14% : 95% confidence int erval [0.02% , 0.29% ]) (mean age 67 years, range 54- 74 years) were found in stead to have recurrent metastatic TCBC involving the duodenum (n = 1) or rectum (n = 2). The patients presented a mean of 32 months after diagnosis of the prim ary TCBC with change in bowel habit (n = 1) and symptoms of bowel obstruction (n = 2). In each patient, initial endoscopy revealed circumferential luminal steno sis and mucosal erythema, but mucosal biopsy specimens revealed normal tissue. E US demonstrated hypoechoic, symmetric, circumferential wall thickening, loss of deep wall layers, and pseudopodia- like extensions into the peri- intestinal t issues. In the two patients with rectal involvement, no evidence of direct infil tration from the bladder bed was seen. EUS- guided FNA was diagnostic of metast atic TCBC in all patients. Conclusions: Although most cases of hypoechoic bowel - wall thickening and stenosis are from primary GI neoplasia, recurrent TCBC sh ould be considered in patients with a history of this tumor. Correct diagnosis i s important, because this allows selection of appropriate therapeutic inter

关键词：胆囊癌移行细胞超声内镜影像学黏膜标本细针穿刺活检患者例数肠腔狭窄胆囊床黏膜红斑

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