胆囊切除与结直肠息肉相关性的研究

Correlation between Cholecystectomy and Colorectal Polyps

背景:胆囊切除已被认为是结直肠癌的危险因素之一,但胆囊切除与结直肠息肉的关系一直未受到重视。目的:探讨胆囊切除与结直肠息肉的相关性。方法:连续收集经结肠镜排除恶性肿瘤、炎症性肠病、家族性腺瘤性息肉病等疾病的患者425例,根据既往有无胆囊切除史分为胆囊切除组(n=63)和对照组(n=362),对两组患者结直肠息肉的发生率、内镜下息肉表现和组织学类型进行分析。结果:胆囊切除组结直肠息肉发生率高于对照组(46.0%对37.8%),但差异无统计学意义(P=0.219)。两组患者息肉的部位和形态均无明显差异(P=0.753,P=0.127);但胆囊切除患者腺瘤性息肉的发生危险显著高于对照组(OR=1.79,P=0.006)。亚组分析示胆囊切除史≥10年的结直肠息肉发生率与胆囊切除史<10年无明显差异(P=0.11)。结论:胆囊切除并未增加结直肠息肉发生的危险性,但腺瘤性息肉的发生率显著增高,因此对胆囊切除患者应重视早期结直肠癌和腺瘤性息肉的筛查。

Background：Cholecystectomy has been proved to be one of the risk factors of colorectal cancer,but few attentions have been paid on the association between cholecystectomy and colorectal polyps.Aims：To explore the correlation between cholecystectomy and colorectal polyps.Methods：A total of 425 consecutive patients in whom cancer, inflammatory bowel disease and familial adenomatous polyposis were excluded by colonoscopy were enrolled.Patients were divided into cholecystectomy group（n=63） and control group（n=362） in accordance with whether they had undergone cholecystectomy.The incidence of colorectal polyps,and the endoscopic characteristics and pathological types of polyps were analyzed.Results：The incidence of colorectal polyps in cholecystectomy group was higher than that in control group（46.0%vs.37.8%）,but the difference was not statistically significant（P=0.219）.No significant differences in location and morphology of polyps were found between the two groups（P=0.753 and P=0.127,respectively）,however,the risk of adenomatous polyps in cholecystectomy group was significantly higher than that in control group（OR=1.79,P= 0.006）.Subgroup analysis showed that no significant difference in incidence of colorectal polyps was found between patients with a postcholecystectomy interval of 10 years or greater and patients with a postcholecystectomy interval of less than 10 years（P=0.11）.Conclusions：Although cholecystectomy does not increase the risk of colorectal polyps,the incidence of adenomatous polyps is significantly higher.Thus it is important to pay emphasis on the screening of early colorectal cancer and adenomatous polyps in patients with cholecystectomy.