结肠息肉的临床特征分析

Analysis of clinical characteristics of colonic polyps

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1～4 cm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1～4 cm,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。

Objective To study the endoscopic morphology of colonic polyps and histopathology of clinical features. Methods The data of colonic polyps cases from digestive endoscopy center in our hospital from 2005 to 2007 were analyzed retrospectively.The detection rate of polyps,endoscopic polyp morphology,histopathological types,canceration rate of polyps,polyp recurrence,newborn and so on were analyzed. Results One hundred and thirty-eight cases of polyps were detected from a total of 633 cases of electronic colonoscopy,the detection rate was 21.80%.Polyps in the sigmoid colon area were most（52 cases）,the detection rate was 8.21%,and the polyps constituent ratio was 37.68%（P0.01）.The diameter of polyps was 1~4 cm in 90 cases,and the polyps constituent ratio was 65.22%（P0.01）;endoscopy showed the pedunculated polyps（69.18%） was significantly higher than sessile polyps（P0.05）.From histopathologic analysis of polyps,the polyps constituent ratio in 96 cases（69.57%） of adenomatous polyps was significantly higher than hyperplastic polyps（P0.01）;adenomatous polyp（62.50%） was significantly more than tubular adenomas in 96 villous adenomas（P0.05）;the canceration rate of villous adenoma was 40%,it was significantly higher than tubular adenoma（16.67%）（P0.05）.After all adenomatous polyp removed（including endoscopic removed and surgical removed）,colonoscopy of 1-year review found that recurrence rates of villous adenoma and tubular adenoma were 28.33% and 8.82%（P0.05）.The new rates were 65% and 88.24%,respectively（P0.05）. Conclusion The predilection sites of colonic polyps are the sigmoid colon;most of endoscopic polyps are 1~4 cm;the pedunculated polyps are majority;the canceration rate of villous adenoma,the recurernce rate of removal after one year are higher than tubular gland tumor,and it is the more malignant potential.