内镜下切除结直肠高危腺瘤随访166例

A follow-up study of 166 cases of advanced colorectal adenomas after polypectomy

目的:探讨结直肠高危腺瘤内镜下切除后的复发特点.对今后高危腺瘤患者规范筛查和合理随访提出指导.方法:收集2004-01/2009-01发现结直肠高危腺瘤并经内镜下切除的患者详细临床资料.对于腺瘤切除后继续在我院内镜随访的患者进行登记.结果:共收集结直肠高危腺瘤497例患者,其中166例腺瘤切除后继续在我院行内镜随访.随访的166例患者一般资料分布:年龄32-82(平均61.64±11.07)岁,其中年龄≥55岁患者128例(128/166,77.11%),男性94例(94/166,56.63%),高危腺瘤以便血为首发症状的患者较多见(71/166,46.38%),且腺瘤表面易形成分叶(75/166,54.82%).首次复查时间为切除后1-28mo,共102例患者(102/166,61.45%)复发.高危腺瘤切除后的复发部位特点:初发于左半结肠的腺瘤易复发于左半结肠,初发于右半结肠的腺瘤易复发于右半结肠(r=0.440,0.387,均P<0.01),将高危腺瘤切除前后的病理表现进行比较未见明显相关性.Cox模型的风险量曲线图提示随时间的延长,从6mo开始患者息肉复发的风险逐渐增大.结论:结直肠高危腺瘤切除后存在复发情况,复发前后病理类型无明显关联,为预防复发应在腺瘤切除后6mo尽早复查.

AIM：To investigate the characteristics of recurrence of advanced colorectal adenomas after polypectomy.METHODS：The clinical data for patients with advanced colorectal adenoma who underwent polypectomy from January 2004 to January 2009 were collected and reevaluated.The patients who had follow-up data were included in the study.RESULTS：A total of 497 patients with diagnosed advanced colorectal adenoma were collected,and follow-up data were available in 166 patients.These patients ranged in age from 32 to 82 years（average,61.64 ± 11.07 years）,and 128 cases had an age of ≥ 55 years（128/166,77.11%）.Ninety-four（94/166,56.63%） patients were males.The most common initial manifestations of advanced adenomas were hematochezia（71/166,46.38%） and lobular changes（75/166,54.82%）.The interval between polypectomy and first reexamination was 1-28 months.There were 102（102/166,61.45%） recurrences in all.Advanced colorectal adenomas in the left hemicolon more likely recurred in the left hemicolon,while those in the right hemicolon more likely recurred in the right hemicolon.No pathological differences were found between recurrent adenomas and original ones（P 0.05）.The hazard curve of Cox model suggested that the risk of recurrence increased gradually from 6 months after polypectomy.CONCLUSION：Advanced colorectal adenomas may recur after polypectomy.No pathological differences were found between recurrent adenomas and original ones.Colonoscopy should be performed 6 mo after polypectomy for detection of possible recurrence.