高危结肠息肉73例分析

An analysis of 73 cases with high-risk colon polyps

目的分析高危结肠息肉内镜与病理特征。方法收集内镜黏膜下切除(EMR)或黏膜下剥离(ESD)完整切除3464枚息肉的病理和内镜资料,分析其与息肉病理特征的关系。结果1955例结肠息肉患者切除的3464枚息肉中,具备重度不典型增生、高级别上皮内瘤变或局灶癌变的息肉82枚(2.4%),分别属于73例患者。87.8%(72/82)的高危息肉主要分布于左半结肠;息肉主要病理类型为管状腺瘤5枚、绒毛管状腺瘤70枚、绒毛状腺瘤7枚。直径≥1cm息肉的高危几率高于<1cm的息肉(P<0.01)。带蒂息肉的总体癌变高于扁平息肉(P<0.01);但直径>1cm的扁平息肉高危息肉发现率为10.7%,显著高于整体水平的2.4%(P<0.01)。结论高危息肉易出现于左半结肠。息肉大小是判断是否存在高危因素的主要指标;直径大于1.0cm的扁平息肉更具有恶变倾向。

Objective To analyze the clinicopathological features of high-risk colon polyps.Methods Data of 3464 colon polyps by endoscopic mucosal resection（EMR）or endoscopic submucosal dissection（ESD）were collected.The cheracteristics of clinicopathology were analyzed.Results Of 3464 colon polyps,82（2.4%）polyps from 73 patients were severe atypical hyperplasia,high-class intraepithelial neoplasia or focal canceration including 5tubular adenoma,70villus-tubiform adenoma and 1villous adenoma,of which 72（87.8%）polyps located in left colon.The possibility becoming high-risk polyps was higher in the polyps with a diameter ≥1cm than those 〈1cm in diameter（P〈0.01）.The focal canceration was more in pedicle polyps than in sessile flat polyps（P〈0.01）.But the percentage of high-risk polyps was more in the sessile flat polyps〉 1cm in diameter than overall detection rate（10.7% vs.2.4%）（P〈0.01）.Conclusion Majority of colon polyps with severe atypical hyperplasia or focal canceration distributed in the left hemicolon.The size of polyps is a key factor to evaluate high-risk polyps.Flat polyps with a diameter〉1.0cm seem to have more trendency of canceration.