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结直肠癌的临床症状谱分析及其对肿瘤诊断时间的影响

Typical symptoms of colorectal cancer and its influence in timely diagnosis

摘要:

目的 探讨结直肠癌临床症状谱特点及其对肿瘤诊断时间的影响.方法 检索北京大学人民医院出院日期在2000年1月1日至2010年12月31日之间的原发性结直肠癌病例共1798例,采用系统抽样抽取符合人选标准的400例并进行回顾性研究.复习住院病历并收集病例的一般资料、肿瘤TNM分期等;收集其他信息包括:(1)结直肠癌的首发症状:最早出现的肿瘤相关的症状或症状群;(2)结直肠癌的就诊症状:导致患者就诊的症状或症状群;(3)就诊时间(患者费时):指患者出现首发症状到就诊的时间;(4)确诊时间(医院费时):患者首次就诊到确诊为大肠癌的时间;(5)诊断时间:就诊时间加确诊时间;(6)结直肠癌误诊率:误诊是指结直肠癌患者被诊断为其他疾病并接受相应治疗时间>30 d的.采用x2检验比较各种分类及比例的不同.结果 400例结直肠癌患者首发症状按其发生频率依次为:大便习惯改变170例次(42.5%),腹痛和(或)腹部不适157例次(39.3%),便血147例次(36.8%)及肛门直肠刺激症状69例次(17.3%);176例(44.0%)患者同时出现两种或两种以上症状.出现首发症状后及时就诊率(患者费时≤15 d)为40.7%(159/391).首发症状包含大便习惯改变者的及时就诊率(25.3%,42/166)明显低于以其他首发症状发病者的及时就诊率(52.0%,117/225,p=0.000).首发症状出现时晚期结直肠癌(TNM分期Ⅱb及以上)比例达到50.0%以上.不同首发症状结直肠癌病理类型、分化程度差异均无统计学意义(均p >0.05).进一步分析就诊症状按发生频率依次为:便血179例次(44.8%),腹痛或腹部不适159例次(39.8%),大便习惯改变155例次(38.8%)及肛门直肠刺激症状69例次(17.3%).50.8%(203例)的患者因2种以上症状合并存在而就诊.59.9%(236/394)的患者为及时确诊病例(医院费时≤15d).以腹痛或腹部不适(52.5%,83/158)就诊者相比其他原因就诊者(64.8%,153/236)及时确诊比例低(p<0.05).以黑便就诊者误诊率(50.0%,10/20)高于其他症状就诊者[26.8%(101/377),P<0.05].结论 结直肠癌患者以大便习惯改变、便血及腹痛为常见首发症状,患者就诊症状谱与首发症状谱类似,其中一半以上患者的就诊、确诊时间延迟.

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abstracts:

Objective To explore the spectrum of typical symptoms associated with colorectal cancer (CRC) and their influence in timely diagnosis.Methods A total of 400 cases were randomly collected from 1798 CRC patients treated at our hospital from January 2000 to December 2010.A retrospective chart review was undertaken for all identified cases.Besides demographics and tumor features,TNM stage was obtained from medical records and pathological forms.Other relevant data were as follows:(1) initial symptom complex,(2) presenting symptom or symptom complex,(3) patient duration:period from initial symptoms to consulting a doctor,(4) hospitalization duration:period from initial seeing a doctor to a confirmed CRC case,(5) diagnostic duration:patient duration plus hospitalization duration,(6) rate of misdiagnosis:CRC subjects being diagnosed and treated as other diseases for at least 30 days was identified as misdiagnosis.x2 tests were used to compare the differences of rates of kinds of symptoms and early diagnosis.Results Among 400 study subjects,the frequencies of initial symptoms in a decreasing order were change in bowl habits (170,42.5%),abdominal pain and/or discomfort (157,39.3%),rectal bleeding (147,36.8%) and anorectal stimulating symptoms (69,17.3%).And 176 cases (44.0%)presented multiple symptoms.Short-term health care seeking (≤ 15 d) after initial symptoms was 40.7%(159/391) within all cases,but only 25.3% (42/166) cases with symptoms of change in bowel habits saw a doctor.The rate was significantly lower than that of other cases (117/225,52.0%,P =0.000) without this symptom.An onset of symptom complex did not lead to short-term health seeking compare to individual symptoms.Above 50% cases were already in late stage (TNM stage later than Ⅱ b) as any of the above initial symptoms appeared.No differences of pathology and differentiate of tumors were found among cases with different initial symptoms (P > 0.05).Further analyzed the consulting symptoms:rectal bleeding 179 frequency (44.8%),abdominal pain or discomfort 159 frequency (39.8%),change in bowl habits 155 frequency (38.8%),and Anal rectum stimulating symptoms 69 frequency (17.3%).50.8% (203 cases)consulted a doctor with multiple symptoms.59.9% (236/394) cases were of short term hospitalization duration(≤ 15 d).However,only 52.5% (83/158) in cases whose consulting symptoms included abdominal pain or discomfort,lower than that in other cases without these symptoms (64.8%,153/236)(P < 0.05).High rate of misdiagnosis (50.0%,10/20) was found in Melena consulter than others (26.8%,101/377,P < 0.05).Conclusions Change in bowel habits,rectal bleeding and abdominal pain are the most common symptoms in CRC.And consulting and initial symptoms are similar.Diagnostic and hospitalization delays are seen in half of CRC cases.

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