摘要
背景:根据报警症状区分器质性和功能性胃肠道疾病的确切作用尚不明了。目的:评价报警症状在上消化道或下消化道疾病诊断中的作用。方法:对2002年10月～2003年12月于上海第二医科大学附属仁济医院消化内镜中心行胃镜或结肠镜检查者中上海本地区患者的报警症状发生情况进行回顾性分析。结果:在14101例因消化不良等症状行胃镜检查者中,发现食管、胃和十二指肠恶性肿瘤202例(1.4%),除1例早期胃癌外,其余均为中、晚期病例。有报警症状者108例(53.5%),其中45岁以下者的报警症状发生率为27.8%,黑便、贫血、进行性吞咽困难和持续或反复呕吐是较特异的报警症状。发现食管、胃和十二指肠良性器质性疾病4017例(28.5%),有报警症状者1281例(31.9%)。胃镜检查无异常发现者9882例(70.1%),有报警症状者381例(3.9%)。在1681例因下消化道症状行结肠镜检查者中,发现结直肠恶性肿瘤83例(4.9%),均为中、晚期病例。有报警症状者68例(81.9%),便血、黑便和贫血是较特异的报警症状,无报警症状的恶性肿瘤患者年龄均大于40岁。发现结直肠良性器质性疾病264例(15.7%),有报警症状者128例(48.5%)。结肠镜检查无异常发现者1334例(79.4%),有报警症状者197例(14.8%)。结论:黑便、贫血、进行性吞咽困难和持续或反复呕吐报警症状有助于鉴别胃癌等上消化道恶性肿瘤与其他良性疾病,对无报警症状的成人消化不良患者作初始处理时,建议行胃镜检查。出现症状时年龄>40岁、便血、黑便和贫血报警症状有助于鉴别结直肠癌等下消化道器质性疾病与功能性疾病,当患者出现下消化道症状同时有报警症状时应行结肠镜检查,而40岁以上无报警症状的患者在作出功能性疾病的诊断前也应行结肠镜检查。
Background： The precise value of distinguishing organic from functional gastrointestinal diseases by warning symptoms and signs has not been clarified. Aims： To assess the clinical value of warning symptoms and signs in the diagnosis of upper and lower gastrointestinal diseases. Methods： The prevalence of warning symptoms of consecutive autochthonous patients referred to the Endoscopy Center, Renji Hospital, Shanghai Second Medical University from October 2002 to December 2003 were analyzed retrospectively. Results： Two hundred and two （1.4%） esophageal and gastroduodenal malignancies were found by gastroscopy in a total of 14 101 patients presented with dyspepsia. Among them, except one was early, all others were moderately advanced or advanced. The overall occurrence of warning symptoms in this group was 53.5% （108/202）, and 27.8% in those less than 45 years old. Melena, anemia, progressive dysphagia and continuous or recurrent vomiting were relatively common. Four thousand and seventeen （28.5%） cases of benign organic esophageal or gastroduodenal diseases and 9 882 （70.1%） cases without causal pathologic findings were found in these 14 101 patients, warning symptoms were present in 31.9% and 3.9% , respectively. Eighty-three （4.9%） patients with colorectal malignancies were found in 1 681 patients referred for colonoscopy due to lower gastrointestinal symptoms. All these malignancies were in the progressive stage. The presence of warning symptoms was 81.9% （68/83）. Hemafecia, melena and anemia were the most common and significant alarming features. All malignant patients without warning symptoms were above 40 years old. Two hundred and sixty-four （15.7%） cases of benign organic colorectal diseases and 1 334 （79.4%） cases ~ith no causal pathologic changes were found in these 1 681 patients, and the presence of warning symptoms were 48.5% and 14.8%, respectively. Conclusions：Melena, anemia, progressive dysphagia and continuous or recurrent vomiting are helpful in distinguishing gastric cancer or other malignancies from functional upper gastrointestinal diseases. For most adult dyspeptics, prompt gastroscopy is recommended as the initial management option. Symptom onset at the age above 40 years,hemafecia, melena and anemia are helpful in distinguishing colorectal cancer from other functional lower gastrointestinal diseases. Colonoscopy should be performed in patients above 40 years of age before making the diagnosis of functional gastrointestinal diseases.
出处
《胃肠病学》
2005年第4期198-202,共5页
Chinese Journal of Gastroenterology
