大肠腺瘤恶变的主要危险因素

Significant risk factors of malignant transformation in colorectal adenoma

目的 探讨大肠腺瘤的分布、大小和形态特点及腺瘤恶变过程中的主要危险因素。方法 回顾性分析和研究 1994年 3月至 1998年 4月期间我院电子结肠镜检出的大肠腺瘤的形态学和恶变过程中的主要危险因素。结果 发现大肠腺瘤 12 0例 14 4个 ,占大肠息肉检出的 62 .18% ;恶变腺瘤以 >2 .0cm、山田Ⅱ型为主 ;腺瘤的恶变率为 16.67% ,绒毛状腺瘤恶变率最高 ,管状腺瘤恶变率次之 ;腺瘤≤ 1.0cm者恶变率 3 .85 % ,1.1～ 1.9cm者恶变率 2 1.0 5 % ,≥ 2 .0cm者恶变率 3 9.47% ;组织学证实管状腺瘤的百分率随着腺瘤的增大而减小 ,绒毛状腺瘤的百分率则随着腺瘤的增大而增加 ,2 4例恶变腺瘤中患者的年龄 5 0岁以上占 91.67% ;而 12例同时伴肠癌腺瘤中患者的年龄大于 5 0岁的占 83 .3 3 %。结论 管状腺瘤是大肠中最常发现的肿瘤性息肉 ,随着腺瘤体积增大 ,管状结构减少 ,绒毛状结构增加 ;大肠腺瘤的大小、形态、病理类型和患者的年龄 (特别是 5 0岁以上 )是大肠腺瘤恶变的主要危险因素。

? Objective This study was designed to evaluate the characteristics of distribution and size of colorectal adenoma,and its principal oncogenesic risk factors.Methods From March,1994 to April,1998,video colonoscopies were performed and retrospectively analyzed in 1810 patients in order to determine the risk factors for oncogenesisResults There were 120 patients with 144 colorectal adenomas,malignantly transformated adenomas exceeded 2.0cm in diameter showed mainly Yamada type Ⅱ; 16.67% colorectal adenomas with malignant change were found,of which the frequency of malignant villous and tubular adenomas were 29.63% and 9.20% respectively.The frequency of transformation was 3.85% in adenomas less than 1.0cm in size,21.05% in adenomas between 1.1 to 1.9cm in size,and as mach as 39.47% in adenomas greater than 2.0cm in size.Histological characteristics demonstrated a decrease of tubular adenomas from 31.03% to 13.79% with the increase of size,while villous adenomas increased inversely from 9.26% to 48.15%.91.67% and 83.33% patients older than 50 years of age were found in 24 patients with maglinant adenomas and 12 patients with adenomas coexisted with cancer repectively Conclusions The tubular adenoma is neoplastic polyp more frequently found.The tubular tissue decreases when the size of adenoma increases,while villus tissue increases.In this study,the size,and histologic type of adenoma and old age are the more significant risk factors for malignant change in our patient group. 〔