大肠息肉的临床、病理及内镜特征

Colorectal polyp:clinical,pathologic and endoscopic features.

目的 探讨大肠息肉的分布、大小、形态和临床、病理、内镜特征及息肉恶变的相关因素。方法 从我院 1998～ 2 0 0 0年所做 5 840例电子结肠镜中检出的大肠息肉患者的临床表现及病理、内镜资料进行分析。结果 在 5 840例肠镜中 ,共检出大肠息肉 6 2 3例 ,息肉的检出率为 10 .6 7% ,而腺瘤性息肉 2 71例占 47.0 9%。主要临床表现为便血。腺瘤性息肉的大小与恶变密切相关。本组息肉以 0 .6～ 1.0 cm者恶变率为 3.80 % ,1.1～ 1.9cm者恶变率为 13.0 % ,≥ 2 .0 cm者恶变率为 2 7.5 9%。结论 腺瘤息肉的恶变与其体积大小有关 ,体积愈大愈易恶变。大肠镜检查应尽量检查全结肠 ,且在取活检时注意选择息肉糜烂处及大息肉多块取材。

Objective The clinical manifestation,colonoscopy and pathology of colorectal polyp and the factors which affect polyp carcinoma sequence were discussed.Methods Five thousand eight hundred and forty cases of colorectal polyp from 1998 to 2000 diagnosed colonoscopically were reviewed and all data on clinical manifestation,endoscopy and pathology were analysed.Results Of the 5840 patients who underwent colonoscopy,623(10.67%) were diagnosed as having colorectal polyp.And,of these 623 patients 739 polyps,271 patients348 polyps(47.09%) were adenomatous.The most common clinical feature was hematochezia.The rates of canceration were calculated for the size of adenoma:3.8% for patients with adenoma 0.6～1cm,13.0% for patients with adenoma 1.1～1.9cm,and 27.59% for patients with adenoma more than 2cm.Conclusion The canceration of adenomatous polyp was found to correlate closely with its size, i.e. ,the larger the adenomatous polyp grows up,the higher the risk of canceration will be .Colonoscopy should be done throughout the whole colon.Biopsy samples should be taken from the erosive part of the polyp.If the polyp is large,multiple biopsy samples should be taken.Once a polyp is discovered,Polypectomy should be performed as thoroughly as possible.