溃疡性结肠炎癌变的回顾性分析

Ulcerative colitis associated colorectal cancer in ulcerative colitis patients: a retrospective analysis

目的分析558例溃疡性结肠炎(UC)发生结直肠癌的风险以及危险因素,为溃疡性结肠炎相关癌(UC-CRC)的监测、筛查以及预防提供依据。方法 1997年1月至2007年12月南方医院共行结肠镜检查32926例,对其中558例UC患者以及UC-CRC患者的相关临床资料进行回顾性分析。结果在558例UC患者中,发现结直肠癌8例,均为进展期癌,总体风险为1.43%,2组病人在年龄、疾病病程、病变范围、诊断结直肠癌前活检是否有不典型增生、是否使用5-ASA类药物、激素治疗以及是否参加内镜随访等方面有显著性差别。危险因素分析提示,疾病病程、病变范围以及结肠镜检查发现不典型增生为UC-CRC的危险因素;定期内镜随访、5-ASA以及激素治疗可降低UC-RC发病的风险。结论 UC患者有较高癌变的风险,但总体风险较西方国家低;UC病程大于10年、全结肠炎以及活检发现有不典型增生是发生结肠癌的高危因素,定期内镜随访以及5-ASA和激素治疗是UC患者防止发生结直肠癌的保护因素。

Objective To analyze the risk and risk factors of ulcerative colitis（UC） associatedcolorectal cancer （CRC） in 558 UC patients and to provide the evidence for UC associated CRC screening surveillance and prevention. Methods Five hundred and fifty-eight UC patients from the 32,926 patients who received colonoscopy in the endoscopy center of Nanfang Hospital from January 1997 to December 2007 were retro- spectively evaluated. Results CRC was diagnosed in 8 patients in 558 UC patients, and the overall incidence of CRC in patients with UC was 1.43%. Longer disease duration, extensive colitis, presence of dysplasia before CRC were identified as risk factors for developing CRC, while regular endoscopic follow-up, 5-ASA and steroids therapy were identified as protective factors for UC-CRC. Conclusion The cumulative risk of CRC was high in our patients with UC; however, it was lower compared with that in western countries. Duration more than 10 years, extensive colitis were identified as important factors for developing CRC. Regular endo- scopic follow-up, 5-ASA and steroids therapy could reduce the risk of UC-CRC.