796例大肠息肉的临床、内镜及病理观察

Clinical, enteroscopic, and pathological characteristics of 796 cases of colorectal polyps

目的:探讨大肠息肉患者的年龄,息肉的发生部位、大小和息肉的病理类型以及息肉癌变的相关规律.方法:对电子肠镜检查中检出的大肠息肉患者的临床表现、内镜及病理资料进行分析.结果:在7 276例肠镜检查患者中,发现大肠息肉796例,其中男性521例,女性275例,检出率10.94%;年龄30～69岁占82.29%;腺瘤性、炎性、增生性、幼年性息肉分别占43.84%,42.09%,11.06%,1.51%;息肉部位分别为盲肠3.29%、升结肠11.88%,横结肠4.89%,降结肠11.58%,乙状结肠26.05%,直肠42.32%.796例中有35例发生癌变,癌变率4.4%.绒毛状腺瘤、混合性腺瘤、管状腺瘤癌变率为29.73%,11.11%,4.86%;息肉直径≤0.5 cm,未发现癌变;0.6～1.0 cm,癌变率1.3%;1.1～1.9 cm,癌变率7.4%;≥2.0 cm,癌变率25.6%.结论:30～69岁大肠息肉发病率较高,男性较女性更易患大肠息肉;息肉好发部位为左半结肠;病理类型以腺瘤性息肉、炎性息肉较常见;左半结肠息肉、直径≥2.0 cm息肉、绒毛状腺瘤容易癌变;大肠息肉不论大小应尽可能予以切除,全瘤送检.内镜切除大肠息肉可预防息肉癌变.

Objective To study the age, clinical , enteroscopic and pathological characteristics of colorectal polyps and factors affected polyp-carcinoma. Methods We analyzed the clinical, enteroscopic and pathological characteristics of 7 276 cases of colorectal polyps. Results The incidence of colorectal polyps was 10.94% , including 521 men and 275 women. The rate of colorectal polyp was 82.29% in 30-69 year olds. The adenomatous, inflammatory, hyperplastic and juvenile polyps were 43.84% , 42.09% , 11.06% and 1.51% , respectively. Polypoid lesions were located at cecum 3.29% , ascending 11.88% , transverse 4.89% , descending 11.58% , sigmoid 26.05% , and rectum 42.32%. Thirtyfive cases （4.4%） were found to have polpous canceration. The canceration rates in villous, mixed and tubular adenomas were 29.73% , 11.11% , and 4.86%. The rate of canceration seemed to depend on its dimensions, being 1.3% , 7.4% , and 25.6% for the 0.6-1.0 cm, 1.1-1.9 cm, and ≥2.0 cm in size, respectively. Conclusion The ages between 30-69 tend to suffer from colorectal polyps. The incidence in the male is higher than that in the female. Colorectal polyps are more likely to locate in left colon. The common pathological types were adenomatous and inflammatory polyps. There is a high canceration of polyps in the left colon, villous adenomas and ≥2.0 cm polyps. The broader the pedicles and the larger the diameters of polyps are, the higher the canceration rate. All of the colon polyps should be excised and undergo the pathological examination. Enteroscopic polypectomy helps prevent colorectal polpous canceration.