32例大肠锯齿状腺瘤临床、结肠镜及病理特点分析

The report about 32 cases of the serrated adenoma that were diagnosed the clinic, endoscopic and pathologic features

目的探讨大肠锯齿状腺瘤患者的临床、结肠镜及病理特点。方法回顾性分析我院2008年4月-2009年12月消化内镜中心及病理科检出的32例大肠锯齿状腺瘤患者的临床、结肠镜及病理特点。结果32例大肠锯齿状腺瘤患者以腹痛就诊者20例（62．5％），腹泻7例（21．7％），便血2例（6．2％），CEA升高体检2例（6．2％），结肠癌术后复查1例（3．1％）；结肠镜检查病变位于直肠者18例（56．2％），位于乙状结肠者3例（9．3％），位于直乙交界处者5例（15．5％），位于降结肠者2例（6．2％），位于横结肠者3例（9．3％），位于升结肠者1例（3．1％）；多发4例（12．5％），单发28例（87．5％）；腺瘤直径多在1～6mm，最大直径20mm，平均直径9．5mm，32例大肠锯齿状腺瘤中广基息肉（Is）25例（77．3％），亚蒂息肉（Isp）6例（19．6％），有蒂息肉（Ip）1例（3．1％）。组织病理学检查为单纯锯齿状腺瘤8例（25．8％），活检结果为锯齿状腺瘤，低级别上皮内瘤变22例（68．2％），锯齿状腺瘤，局部高级别上皮内瘤变1例（3．1％），锯齿状腺瘤，局部恶变1例（3．1％），手术后病理证实为中分化腺癌。结论大肠锯齿状腺瘤作为一种独立的腺瘤形态与直结肠肿瘤密切相关，应引起重视。

Objective To investigate the clinic, endoscopic and pathologic features of the large intestine serrated adenoma. Methods Retrospective analysis was performed on the clinic,endoscopic and pathologic features on 32 cases of the serrated adenoma that were diagnosed by the Digestive Endoscope Center and the Pathology Department of our hospital between Apr. 2008 and Dec. 2009. Results In the 32 patients with serrated adenoma,20 cases consulted the doctor with bellyache（ 62.5% ）,7 with diarrhea （21.7%） ,2 with hematochezia（6.2% ） ,2 with high CEA, 1 with colon carcinoma post-operation reexam- ination. 23 cases are male（ 71.9% ）and 9 are female （28.1）. 29 cases are the Han nationality （90.6%） and 3 are the Uigur,with the average age being 52.4. The endoscopic findings show that the locations of the pathological changes are distributed in the colon rectum（ 18 cases, 56.2% ）, the sigmoid flexure （3 cases,9.3% ）,the boundary between the rectum and the sigmoid flexure（5 cases, 15.5% ）, the colon descendent（2 cases, 6.2% ） , the colon transversum （ 3 cases, 9.3% ） , and the colon asecndent （ 1 case, 3.1% ）. 4 cases are multiple abscess（ 12.5% ） and 28 are single abscess（ 87.5% ）. The diameters of the most adenomas are 1 mm-6 mm,with the largest being 20mm and the average being 9.5 mm. The Is cases are 25（77.3% ） ,the Isp 6（ 19.6% ） ,the Ip 1 （3.1%）. By Histopathology,8 cases are simply serrated adenoma（25.8% ）, 22 low-level intraepithelial neoplasia（68.2% ）, 1 high-level intraepithelial neoplasia （3.1% ）, 1 local canceration（ 3.1% ）, which was confirmed as moderately differentiated adenoma after operation. ConclusionAs an independent form of adenoma, the large intestine serrated adenoma is closely related with the colon rectum tumor, and should pay attention to.