1578例大肠息肉的病理类型与癌变因素探讨

The Pathological Type and Carcinogenesis Factors on 1578 Cases of Colorectal Polyp

目的:探讨大肠息肉的各种病理类型与癌变相关因素。方法:选择2002年1月至2011年12月在本院肠镜检查检出大肠息肉患者1578例,回顾性研究大肠息肉的发病年龄、部位、大小、形态、病理类型与癌变因素。结果:大肠息肉检出率为22.72%,癌变率5.64%;不同年龄检出率有统计学差异(X2=8.250,P=0.016),中年患者检出率高;大肠息肉在直肠(32.00%)乙状结肠检出(35.80%)最常见,息肉直径≤1cm较常见(78.90%),在直径1cm-2cm的息肉中腺瘤性息肉占比最高(70.12%),形态研究发现无分叶状息肉较常见(80.04%);癌变因素研究发现老年患者(X2=10.070P=0.002)、发生部位在直肠及乙状结肠(X2=0.843 P=0.016)、息肉直径>2cm(X2=114.173 P<0.001),分叶状息肉(X2=16.66 P<0.001)、三种腺瘤性息肉(X2=71.14 P<0.001)较其它因素癌变率显著增加。结论:大肠息肉的发病与年龄性别密切相关;不同病理类型的大肠息肉临床特点明显不同;直肠和乙状结肠、分叶、腺瘤性、直径>2.0cm的息肉是发生癌变的高危因素;对大肠息肉须及时治疗,定期随访,减少大肠癌的发生。

Objective： To investigate the various pathological types of colorectal polyps and carcinogenesis-related factors.Method： 1578 cases of colorectal polyps detected by colonoscopy in our hospital from January 2002 to December 2011,reviewing the incidence of colorectal polyps,age,location,size,shape,and the pathological type of carcinogenesis factors.Result： Colon polyp detection rate was 22.72%,carcinogenesis rate was 5.64%;A significant difference of different age groups are detected（X2= 8.250,P = 0.016）,with a high detection of middle-aged patients.Colorectal polyps occurred in common in the rectum（32.00%） and sigmoid colon（35.80%）,with polyp diameter ≤ 1cm（78.90%）.Adenomatous polyps was the highest proportion in the diameter of 1cm-2cm polyps（70.12%）.Morphological studies found non-lobulated polyps were more common（80.04%）.It was found in carcinogenesis factors that elderly patients（X2= 10.070 P = 0.002）,occurrence in the rectum and sigmoid colon（X2= 0.843 P = 0.016）,polyp diameter 2cm（X2= 114.173,P 0.001）,lobulated polyps（X2= 16.66,P 0.001）,adenomatous polyposis coli（X2= 71.14 p = 0.001） increased carcinogenesis rate significantly compared with other factors.Conclusion： The incidence of colorectal polyps are closely related to the age and sex;Different pathological types of colorectal polyps had significantly different clinical features;Occurrence in the rectum and sigmoid colon,non-lobulated,adenomatous polyposis coli diameter 2.0cm are risk factors of carcinogenesis;Colorectal polyps is timely to treat,regular follow-up and therefore reducing the incidence of colorectal cancer.