结直肠腺瘤切除术后结肠镜随访时间间隔分析

The Surveillance Interval of Patients With Adenoma After Polypectomy

目的探讨不同类型腺瘤患者在内镜下切除腺瘤后结肠镜随访间隔时间。方法对1976年至2007年在广州南方医院消化内镜中心,所有经结肠镜下诊断并切除腺瘤患者的随访结果进行回顾性分析,记录初次结肠镜检查腺瘤的大小、部位、数量、形态和组织病理结果,以及患者的年龄、性别和随访结肠镜检查结果。根据进展期腺瘤的复发风险,将患者分为高风险组和低风险组,对随访终点有5%（t0.05）,10%（t0.10）,20%（t0.20）患者发生进展期腺瘤时所对应的时间段进行估算。用Bootstrap抽样方法随机抽样,并分别计算高风险组和低风险组与t0.05、t0.10、t0.20各分位数所对应的时间。结果当在5%的随访患者中出现进展期腺瘤时,低风险组患者的随访时间大概是6.9年（95%CI：6.3~12.2）,而高风险组患者的随访时间大概是3.0年（95%CI：2.7~3.2）。若10%的随访患者最终发展为进展期腺瘤,低风险组患者随访时间约为12.6年（95%CI：8.5~14.5）,高风险组的随访时间约为4.2年（95%CI：3.5~5.0）。而当随访患者中进展期腺瘤复发患者达到20%时,低风险组和高风险组的随访时间分别约为15.0年（95%CI：14.2~17.1）和5.6年（95%CI：5.0~6.3）。结论对于高风险和低风险组患者在腺瘤切除后3年和6.9年随访是安全的。

Objective Subject to discuss the surveillance interval of patients with different type adenoma after polypectomy.Method All cases of colorectal adenoma removed by colonoscopy between1976 and2007 have therefore been documented in the endoscopic center of the Gastroenterology,Department at NanFang Hospital,Guangzhou,and the follow-up result of every patient has been analyzed respectively.Data on patients in the study interval（January 1976 to December 2007）include the characteristics of the adenoma（size,location,number,shape,and histopathology）,age and sex of the patient,and outcomes of surveillance colonoscopy have been documented.We classified patients into two risk groups based on the stratified risk of advanced adenoma recurrence in the multivariate analysis.we calculated the times required for5（t0.05）,10（t0.10）,and 20%（t0.20）of the patients,stratified on the basis of the risk factors for advanced adenoma recurrence at the surveillance colonoscopy,We used the bootstrap sampling method to randomly pick out samples from eligible patients in each sampling test and calculated the times corresponding to the above-mentioned.Result With a recurrence of advanced adenomas in 5%of patients,the estimate was 6.9（95% CI 6.3-12.2）years in the low-risk group and 3.0（95% CI 2.7-3.2）years in the high risk group.The estimate for the 10%quantile（the time when 10%of patients will develop advanced adenoma）was12.6（95%CI 8.5-14.5）years in the low-risk group and4.2（95%CI 3.5-5.0）years in the highrisk group.With a recurrence of advanced adenomas in20%of patients,the estimate was 15.0（95%CI 14.2-17.1）years in the low-risk group and 5.6（95% CI 5.0-6.3）years in the high-risk group.Conclusion A surveillance colonoscopy at 3 years for high-risk patients and one at 6.9 years for low-risk patients are safety.