摘要
目的探讨结直肠息肉的不同临床病理特点和不同类型腺瘤性息肉切除术后合适的随访时间,以期指导临床医师对患者进行针对性的干预和治疗。方法选择2015年1月—2017年12月在上海市健康医学院附属嘉定区中心医院行结肠镜检查的患者3968例,根据有无临床症状分为有症状组(1787例)和无症状组(2181例),结肠镜检查发现结直肠息肉并经病理学检查证实789例。比较有症状组与无症状组息肉检出比例,不同性别、年龄患者的息肉检出比例,各病理类型息肉、低危和高危腺瘤性息肉检出比例,腺瘤性息肉的发生部位、大小、数量;比较有症状组不同临床症状患者各病理类型息肉、低危和高危腺瘤性息肉检出比例,以及腺瘤性息肉的发生部位、大小和数量。分别于术后6~12、13~24、25~36、37~48个月4个随访时间段观察腺瘤性息肉复发和癌变情况,估算低危和高危腺瘤性息肉患者的复发时间。结果所有患者中息肉检出比例为19.8%(789/3968),有症状组的息肉检出比例(27.3%)显著高于无症状组(13.8%,P<0.05)。有症状组和无症状组男性患者息肉检出比例均显著高于同组女性患者(P值均<0.05);有症状组男性患者的息肉检出比例显著高于无症状组(P<0.05)。有症状组和无症状组>50岁患者的息肉检出比例均显著高于同组≤50岁患者(P值均<0.05)。有症状组与无症状组间各病理类型息肉检出比例的差异有统计学意义(P<0.05)。有症状组不同临床症状间各病理类型息肉检出比例的差异有统计学意义(P<0.05),有症状组便血患者与便秘、腹泻、腹痛和其他临床症状患者间各病理类型息肉检出比例的差异有统计学意义(P<0.05),便血患者腺瘤性息肉和癌变息肉占比均显著高于炎性息肉、增生性息肉(P值均<0.05)。有症状组和无症状组高危腺瘤性息肉检出比例均显著低于同组低危腺瘤性息肉(P值均<0.05),有症状组高危腺瘤性息肉检出比例显著高于无症状组(P<0.05)。有症状组中不同临床症状低危腺瘤性息肉与高危腺瘤性息肉占比的差异有统计学意义(P<0.05)。有症状组和无症状组腺瘤性息肉均主要位于乙状结肠和直肠,两组间腺瘤性息肉发生部位的差异无统计学意义(P>0.05)。有症状组最大径<10 mm腺瘤性息肉患者比例显著高于无症状组(P<0.05);有症状组和无症状组均以单发息肉多见,有症状组有≥2个腺瘤性息肉的患者比例显著高于无症状组(P<0.05)。高危腺瘤性息肉患者复发率为38.0%(27/71)、癌变率为15.5%(11/71),均显著高于低危腺瘤性息肉患者的4.6%(11/240)和0.8%(2/240,P值均<0.05)。术后13~24、25~36、37~48个月高危腺瘤性息肉患者的复发率和癌变率均显著高于低危腺瘤性息肉患者(P值均<0.05)。低危腺瘤性息肉患者中位复发时间为40(35,42)个月,高危腺瘤性息肉患者中位复发时间为40(28,45)个月。结论结直肠息肉的临床表现不典型,便血、高龄等因素在评估患者预后时具有参考价值。建议腺瘤术后40个月进行结肠镜随访。
Objective To investigate the difference between clinicopathological characteristics of colorectal polyps and the appropriate follow-up time after resection of different type adenomatous polyps in order to guide clinicians to carry out targeted intervention and treatment for patients.Methods Patients who underwent colonoscopy were collected retrospectively from 2015 to 2017 in our hospital.According to the clinical symptoms,the patients were divided into the symptomatic group(1787 cases)and the asymptomatic group(2181 cases),789 cases of colorectal polyps found by colonoscopy and confirmed by pathology.To compare the detection rate of polyps in the symptomatic group and the asymptomatic group in patients of different genders and ages,and to compare the detection rate of polyps of various pathological types,low-risk and high-risk adenomatous polyps,as well as the location,size and quantity of adenomatous polyps;To compare the detection rate of pathological polyps,low-risk and high-risk adenomatous polyps,and the location,size and quantity of adenomatous polyps in patients with different clinical symptoms in the symptomatic group.Results The detection rate of polyps in all patients was 19.8%(789/3968),and that in symptomatic group was 27.3%,significantly higher than that in asymptomatic group(13.8%,P<0.05).In symptomatic group and asymptomatic group,the detection rate of polyps in male patients was significantly higher than that in female patients in the same group(both P<0.05);The detection rate of polyps in male patients in the symptomatic group was significantly higher than that in the asymptomatic group(P<0.05).In symptomatic group and asymptomatic group,the detection rate of polyps in patients over 50 years old was significantly higher than that in patients under 50 years old in the same group(P<0.05).There was significant difference between the symptomatic group and the asymptomatic group(P<0.05).In the symptomatic group,there was significant difference in the detection rate of polyps of different pathological types between patients with hematochezia and those with constipation,diarrhea,abdominal pain and other clinical symptoms(P<0.05),The adenomatous polyps rate and cancerous polyps rate in patients with hematochezia was significantly higher than that of inflammatory polyps and hyperplastic polyps(all P<0.05).In symptomatic group and asymptomatic group,high-risk adenomatous polyps rate was significantly lower than that of low-risk adenomatous polyps(both P<0.05),and the detection rate of high-risk adenomatous polyps in symptomatic group was significantly higher than that in asymptomatic group(P<0.05).In the symptomatic group,there was significant difference in the low-risk and high-risk adenomatous polyps rate between different clinical symptoms(P<0.05).In symptomatic group and asymptomatic group,adenomatous polyps were mainly located in sigmoid colon and rectum,there was no significant difference between the two groups in the location of adenomatous polyps(P>0.05).The patients with adenomatous polyps less than 10 mm in diameter in the symptomatic group were more than those in the asymptomatic group(P<0.05);Single polyp was common in symptomatic group and asymptomatic group,the number of polyps≥2 in the symptomatic group was significantly higher than that in the asymptomatic group(P<0.05).The recurrence rate was 38.0%(27/71)and canceration rate was 15.5%(11/71)in high-risk adenomatous polyps,which were significantly higher than 4.6%(11/240)and 0.8%(2/240,both P<0.05)in low-risk adenomatous polyps.The recurrence rate and canceration rate of low-risk adenomatous polyps and high-risk adenomatous polyps were statistically significant(P<0.05)in 6-12 months,12-24 months,25-36 months and 37-48 months after operation.The median recurrence time of low-risk adenomatous polyps was 40(35,42)months,and that of high-risk adenomatous polyps was 40(28,45)months.Conclusion The clinical manifestations of colorectal polyps are not typical,among which hematochezia and old age have reference value.We suggest a 40 months surveillance interval for patients.
作者
林媛
丁刚玉
王善娟
张燕华
LIN Yuan;DING Gangyu;WANG Shanjuan;ZHANG Yanhua(Department of Neurology Internal Medicine,Jiading District Central Hospital Affiliated to Shanghai University of Medicine and Health Sciences,Shanghai 201800,China)
出处
《上海医学》
CAS
北大核心
2019年第11期651-656,共6页
Shanghai Medical Journal
基金
上海市嘉定区科学技术发展基金—嘉定区重点学科资助项目(消化肿瘤方向)(2017ZD01).
关键词
复发
结直肠息肉
临床症状
病理类型
Recurrence
Colorectal polyps
Clinical symptoms
Pathological types
作者简介
通信作者:张燕华,电子邮箱为18930862626@163.com
