臨床上結(jié)腸鏡檢查手術(shù)過程中,，一根前頭裝備攝像頭的軟管順著患者口腔食管一直插入直腸中,，然后將軟管滑行延伸至患者結(jié)腸部位。在進行結(jié)腸鏡檢查時,，尚未發(fā)生癌變的腺瘤性息肉是結(jié)腸部位最常見的異樣物質(zhì),。如果在做結(jié)腸鏡檢查手術(shù)時不及時將它切除的話，腺瘤性息肉有很有可能發(fā)生癌變,，導(dǎo)致結(jié)腸癌的發(fā)生,。
美國癌癥研究院統(tǒng)計顯示：2011年，美國有100,000對例新增結(jié)腸癌病例,，40,000多例新增直腸癌病例,，有49,000名結(jié)腸/直腸癌患者死亡。來自美國Memorial Sloan-Kettering癌癥中心的研究人員早些時候完成的一項研究證實在進行結(jié)腸鏡檢查的時候,，切除癌前期息肉能起到預(yù)防結(jié)腸癌發(fā)展的作用,。2月23日，N Engl J Med上刊出的一篇研究論文指出：在結(jié)腸鏡檢查時切除癌前期息肉能使患者因結(jié)腸癌死亡的風(fēng)險減半,。該研究也是由美國Memorial Sloan-Kettering癌癥中心領(lǐng)導(dǎo),，研究人員包括內(nèi)視鏡專家、病理學(xué)家,、放射學(xué)家和流行病學(xué)家等,。
該項研究的主要領(lǐng)導(dǎo)者Memorial Sloan-Kettering癌癥中心的生物統(tǒng)計學(xué)家--Ann G. Zauber博士稱：這項研究證實了我們能從切除結(jié)腸部位腺瘤性息肉手術(shù)中長期受益,，我們完全可以利用結(jié)腸鏡檢查手術(shù)篩查50歲以上的群體是否罹患結(jié)腸癌。
Zauber等人調(diào)查研究了NPS數(shù)據(jù)庫中患者病例信息,，NPS（美國息肉研究）收錄了1980至1990年間，美國各地患者接受結(jié)腸鏡檢查的相關(guān)信息,。工作者收集了2,602名在結(jié)腸鏡檢查手術(shù)中切除腺瘤性息肉的患者信息,，并進行隨訪，其中最長的追訪研究長達23年,。結(jié)果發(fā)現(xiàn)在15.8年（中位數(shù)）以后,，有1,246名患者因為罹患其他疾病病去世，因罹患結(jié)腸癌去世的人數(shù)只有12名,。
研究人員還發(fā)現(xiàn)不管癌癥患者之前長得是不是已經(jīng)癌變或是未發(fā)生癌變的腺瘤性息肉,，在接受結(jié)腸鏡檢查時切除息肉后的頭十年里，結(jié)腸癌患者死亡率都很低,。
該研究另一主要領(lǐng)導(dǎo)者--消化系統(tǒng)癌癥專家Winawer教授認為結(jié)腸鏡檢查術(shù)應(yīng)該作為美國結(jié)腸癌篩查指南中的關(guān)鍵部分,，要在全球范圍內(nèi)進行推廣。（生物谷Bioon.com）
doi:10.1056/NEJMoa1100370
PMC:
PMID:
Colonoscopic Polypectomy and Long-Term Prevention of Colorectal-Cancer Deaths
Ann G. Zauber, Ph.D., Sidney J. Winawer, M.D., Michael J. O'Brien, M.D., M.P.H., Iris Lansdorp-Vogelaar, Ph.D., Marjolein van Ballegooijen, M.D., Ph.D.,et al.
Background
In the National Polyp Study (NPS), colorectal cancer was prevented by colonoscopic removal of adenomatous polyps. We evaluated the long-term effect of colonoscopic polypectomy in a study on mortality from colorectal cancer.
Methods
We included in this analysis all patients prospectively referred for initial colonoscopy (between 1980 and 1990) at NPS clinical centers who had polyps (adenomas and nonadenomas). The National Death Index was used to identify deaths and to determine the cause of death; follow-up time was as long as 23 years. Mortality from colorectal cancer among patients with adenomas removed was compared with the expected incidence-based mortality from colorectal cancer in the general population, as estimated from the Surveillance Epidemiology and End Results (SEER) Program, and with the observed mortality from colorectal cancer among patients with nonadenomatous polyps (internal control group).
Results
Among 2602 patients who had adenomas removed during participation in the study, after a median of 15.8 years, 1246 patients had died from any cause and 12 had died from colorectal cancer. Given an estimated 25.4 expected deaths from colorectal cancer in the general population, the standardized incidence-based mortality ratio was 0.47 (95% confidence interval [CI], 0.26 to 0.80) with colonoscopic polypectomy, suggesting a 53% reduction in mortality. Mortality from colorectal cancer was similar among patients with adenomas and those with nonadenomatous polyps during the first 10 years after polypectomy (relative risk, 1.2; 95% CI, 0.1 to 10.6).
Conclusions
These findings support the hypothesis that colonoscopic removal of adenomatous polyps prevents death from colorectal cancer. (Funded by the National Cancer Institute and others.)
