结直肠息肉内镜下特点及治疗

Features of colonoscopy diagnosis and treatment of colorectal polyps

背景与目的:结直肠癌是常见的肿瘤,近年来发病率呈上升趋势。多数结直肠癌起源于腺瘤性息肉,而息肉的发现和切除可降低结直肠癌的发病率。为此,我们探讨不同年龄组的结直肠息肉的临床和内镜特点以及内镜下治疗情况。方法:2009年1月—2010年1月在复旦大学附属肿瘤医院内镜科接受肠镜检查的患者5152例,按年龄分为中青年组(<60岁)和老年组(≥60岁)。比较分析两组资料结直肠息肉的肠镜下特点和病理类型,以及内镜下息肉治疗情况。结果:老年组的结直肠息肉检出率和息肉癌变率(37.65%,11.18%)均高于中青年组(19.8%,7.43%),差异均有统计学意义(P=0.000)。两组的息肉好发于直肠和乙状结肠(30.53%,29.62%;29.78%,25.29%),均以腺瘤性息肉为多(61.19%,36.99%);而数目多、广基≥2cm以及病理为绒毛状腺瘤的息肉,癌变率较高。除息肉癌变和巨大息肉外,两组资料中80%以上息肉予肠镜下治疗(80.8%,91.3%)全部顺利完成,未有严重并发症发生。结论:结肠镜检查是发现并处理息肉的有效手段,腺瘤性息肉的形态、大小、数目和病理以及患者的年龄与腺瘤性息肉的恶变有一定关系;结直肠息肉应尽可能内镜下治疗,并定期随访,减少结直肠癌的发生。

Background and purpose：Colorectal cancer （CRC） is one of the most common cancers, its morbidity rate has risen in recent years. Most CRC arise from colorectal polyps. Therefore, the finding and removal of polyps may reduce the risk of CRC. In this study, we investigated the clinical features of colorectal polyps between two aged-groups as well as endoscopic polypectomy. Methods：Five thousand one hundred and fifty-two patients with colonoscopy in the Department of Endoscopy, Cancer Center, Fudan University were divided into two groups; the younger group with age 60 years old and the elderly group with age ≥60 years old. The clinical data, colorectal polyps features, pathologic characters and endoscopic polypectomy of the two groups were analyzed and compared. Results： The detection rate （37.65%） and incidence for colorectal cancer （11.18%） in the elder group were significantly higher than those in the young and mid-aged one （19.8%, 7.43%. P=0.000）. The colorectal polyps were usually located in the rectal and sigmoid region （30.53%,29.62% in younger group;29.78%,25.29% in elderly group）. The adenoma polyps were dominant （61.19%,36.99%）. Multiplicity, sizes greater than 2 cm, villous adenomas and sessile polyps were related to a high frequency of polyp malignancy. Apart from larger polyps and malignancy, 80% of all patients underwent colonoscopic polypectomy with no severe complications. Conclusion：Colonoscopy is an effective measure to take for the detection of colorectal polyps and polypectomy, especially in the elderly patients. The characteristics of adenoma polyps, such as the size, multiplicity, pathology, morphosis and the age of a patient may be the relative factors of carcinoma development in colorectal adenomas. Endoscopic polypectomy should be done in patients with detected polyps and the regular follow-ups should be scheduled to reduce the incidence of colorectal cancer.