结肠息肉的临床特征分析

结肠息肉的临床特征分析

杜爱民1,毛　勇1,石延敏1,程传苗2

1.解放军第85医院消化科,上海200052;

2.第二军医大学长征医院医教部

【摘要】　目的　研究结肠息肉内镜下的形态和病理组织学等临床特征。方法　回顾分析我院消化内镜中心2005年～2007年期间检出的结肠息肉病例,分析息肉的检出率、内镜下息肉形态、病理组织学类型、息肉癌变率、息肉术后复发、新生等情况。结果　633例电子肠镜检查共检出息肉病例138例,检出率为21.80%,以乙状结肠部位息肉数量最多,为52例,检出率8.21%,占息肉构成比37.68%(P<0.01)。息肉直径在1～4c m之间者90例,占息肉构成比65.22%(P<0.01);内镜下表现为有蒂息肉所占的比例(69.18%)明显高于无蒂息肉(P<0.05)。从息肉病理组织学上分析,腺瘤性息肉为96例,占息肉构成比69.57%,明显高于增生性息肉(P<0.01);96例腺瘤性息肉中绒毛状腺瘤占62.50%,明显多于管状腺瘤(P<0.05);绒毛状腺瘤的癌变率为40%,明显高于管状腺瘤的16.67%(P<0.05)。所有腺瘤性息肉经摘除术后(包括内镜下摘除和外科手术摘除)1年复查肠镜,发现绒毛状腺瘤和管状腺瘤的术后复发率分别为28.33%和8.82%(P<0.05),而新生率接近,分别为65%和88.24%(P>0.05)。结论　结肠息肉的好发部位以乙状结肠居多;内镜下息肉大小多数在1～4c m,以有蒂息肉居多;绒毛状腺瘤的癌变率、摘除术后1年的复发率均高于管状腺瘤,更具有恶变潜能。

【关键词】　电子结肠镜;腺瘤性息肉;绒毛状息肉;管状腺瘤;癌变

中图分类号:R574.62 文献标识码:A 文章编号:1006-5709(2010)01-0053-03 收稿日期:2009204228

Ana lysis of cli n i ca l character isti cs of colon i c polyps

DU A i m in1,MAO Yong1,SH I Yan m in1,CHENG Chuan m iao2

1.Depart m ent of Gastr oenter ol ogy,the85th Hos p ital of P LA,Shanghai200052;

2.Depart m ent of Medical Educati on, Second M ilitary Medical University,China

【Abstract】　O bjecti ve　To study the endoscop ic mor phol ogy of col onic polyp s and hist opathol ogy of clinical features. M ethods　The data of col onic polyp s cases fr om digestive endoscopy center in our hos p ital fr om2005t o2007were ana2 lyzed retr os pectively.The detecti on rate of poly p s,endoscop ic polyp mor phol ogy,hist opathol ogical types,cancerati on rate of polyp s,polyp recurrence,ne wborn and s o on were analyzed.Results　One hundred and thirty2eight cases of polyp s were detected fr om a t otal of633cases of electr onic col onoscopy,the detecti on rate was21.80%.Polyp s in the sig moid col on area were most(52cases),the detecti on rate was8.21%,and the poly p s constituent rati o was37.68% (P<0.01).The dia meter of polyp s was1～4c m in90cases,and the polyp s constituent rati o was65.22%(P< 0.01);endoscopy showed the pedunculated polyp s(69.18%)was significantly higher than sessile polyp s(P<0.05). Fr om hist opathol ogic analysis of polyp s,the polyp s constituent rati o in96cases(69.57%)of adeno mat ous polyp s was significantly higher than hyper p lastic polyp s(P<0.01);adenomat ous polyp(62.50%)was significantly more than tu2 bular adenomas in96vill ous adenomas(P<0.05);the cancerati on rate of vill ous adenoma was40%,it was signifi2 cantly higher than tubular adenoma(16.67%)(P<0.05).After all adenomat ous polyp re moved(including endoscop2 ic re moved and surgical re moved),col onoscopy of12year revie w f ound that recurrence rates of vill ous adenoma and tu2 bular adenoma were28.33%and8.82%(P<0.05).The ne w rates were65%and88.24%,res pectively(P> 0.05).Conclusi on　The p redilecti on sites of col onic polyp s are the sig moid col on;most of endoscop ic polyp s are 1～4c m;the pedunculated polyp s are maj ority;the cancerati on rate of vill ous adenoma,the recurernce rate of re moval after one year are higher than tubular gland tumor,and it is the more malignant potential.

【Key words】　Electr onic col onoscopy;Adenomat ous polyposis;V ill ous polyp s;Tubular adenoma;Cancerati on

结肠息肉是一种好发于结肠任何部位的常见消化道疾病,它起源于结肠黏膜上皮的增生物,组织学上分肿瘤性和非肿瘤性。肿瘤性主要分为管状、绒毛状腺瘤。非肿瘤性肿物则习惯称息肉,分为增生性、炎症性和错构瘤性[1]。本文对近3年肠镜检查发现的结肠息肉包括癌变息肉病例做一回顾性总结,以探讨结肠息肉的发病规律、癌变息肉术后的再发几率大小,强调息肉术后内镜随访的重要性。

1　资料与方法

1.1　临床资料　138例息肉病例均系我院消化内镜中心于2005年5月～2007年12月期间对633例门诊