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目的探讨青年大肠癌的临床特点及误诊原因。方法回顾分析本院2000年1月至2008年1月确诊的青年大肠癌112例和老年大肠癌542的临床资料,分析两组患者的发病因素、临床特征、病理特点、预后及误诊原因。结果①青年组中有家族史者占18.8%,明显高于老年组4.4%(P(0.01);青年组中有不良生活方式(吸烟、饮酒、饮食不规律)占58.0%,明显高于老年组25.3%(P(0.01);②两组患者均以便血和排便习惯为主要临床表现,青年组便血、腹痛发生率均明显高于老年组(P(0.01);两组患者病变部位均以直肠为主,青年组右半结肠癌发生率明显高于老年组(P(0.01)。③青年组低分化、未分化腺癌、粘液腺癌、印戒细胞癌占70.5%,明显高于老年组33.9%(P(0.01);青年组Dukes分期C、D期占76.8%,明显高于老年组49.1%(P(0.01)。④青年组误诊率65.2%明显高于老年组24.4%(P(0.01);青年组1、3、5年生存率分别为58.7%、20.2%和10.6%,明显低于老年组的90.2%、55.3%和34.9%(P均(0.01)。⑤误诊原因:客观上青年人耐受力强,早期症状不典型,易与其他良性疾病相混淆;主观上医师对青年大肠癌重视不够,未做直肠指诊、大便常规及隐血等常规检查。结论青年大肠癌分化程度低、恶性程度高、转移早、发展快,易贻误诊断,预后不良,故加深对青年大肠癌的认识,提高早期诊疗水平,对社会和家庭都有重要意义。
Objective To investigate the clinical features and misdiagnosis of young colorectal cancer. Methods The clinical data of 112 patients with colorectal cancer and 542 elderly patients diagnosed from January 2000 to January 2008 in our hospital were retrospectively analyzed. The incidence, clinical features, pathological features, prognosis and misdiagnosis of the two groups were analyzed. Results ① There were 18.8% family history in the youth group, which was significantly higher than 4.4% in the elderly group (P (0.01)). The young group had 58.0% of unhealthy lifestyles (smoking, drinking and eating disorders) (P (0.01)). ② The two groups of patients took the blood in the stool and defecation habits as the main clinical manifestations. The incidences of blood in the stool and abdominal pain in the youth group were significantly higher than those in the elderly group (P <0.01). The lesions in both groups were The incidence of right colon cancer in the youth group was significantly higher than that in the elderly group (P <0.01) .③The poorly differentiated, undifferentiated adenocarcinoma, mucinous adenocarcinoma and signet-ring cell carcinoma in the youth group were 70.5%, significantly higher than those in the elderly (P (0.01)). The Dukes staging in stage C and D accounted for 76.8% in young group, which was significantly higher than that in elder group (49.1%, P <0.01) .④The misdiagnosis rate in youth group was 65.2% (P <0.01). The 1-, 3-, 5-year survival rates of young group were 58.7%, 20.2% and 10.6% respectively, which were significantly lower than those of 90.2%, 55.3% and 34.9% Objectively young people with strong tolerance, early symptoms are not typical, easy to be confused with other benign diseases; subjective physicians have not paid enough attention to young people with colorectal cancer, not done rectal examination, stool routine and occult blood and other conventional (P0.05) .Conclusion Youth colorectal cancer has low differentiation, high malignancy, early metastasis, rapid development, easy diagnosis and poor prognosis, so it deepens the understanding of colorectal cancer and improves the early diagnosis and treatment of colorectal cancer, which is of great significance to society and family.