结直肠锯齿状病变内镜与病理学特征分析

Endoscopic and pathological features of colorectal serrated lesion

目的：探讨结直肠锯齿状病变内镜下形态和病理组织学特征。方法回顾性分析福建省立医院消化内镜中心2006年1月至2011年12月检出的结直肠息肉病例，了解结直肠锯齿状病变的检出率、内镜下形态和病理组织学特征。结果59491例肠镜检查共检出息肉病例14403例，检出率为24.21%；其中锯齿状病变78例（91枚），检出率为0.13%，占息肉构成比为0.54%。男女之比为1.6：1，以40～69岁多发，平均年龄55.76岁，单发多见，常见于直肠和乙状结肠，但升结肠也不少见。直径〈10 mm者明显多于≥10 mm者，以无蒂和亚蒂息肉多见。91枚结直肠锯齿状病变中，增生性息肉（HP）68枚（74.7%），传统锯齿状腺瘤（TSA）9枚（9.9%），无蒂锯齿状腺瘤（SSA/P）14枚（15.4%）。14枚 SSA/P中有10枚位于升结肠。病理学检查为单纯锯齿状病变不伴上皮内瘤变43枚（47.3%），伴低级别上皮内瘤变47枚（51.6%），伴高级别上皮内瘤变1枚（1.1%）。直径≥10 mm的锯齿状病变伴上皮内瘤变者明显高于直径〈10 mm者；亚蒂和无蒂结直肠锯齿状病变伴上皮内瘤变者明显高于有蒂者。结论结直肠锯齿状病变具有腺瘤性息肉的一些特点，直径≥10 mm及亚蒂和无蒂的结直肠锯齿状病变更易伴不同程度的上皮内瘤变。

ObjectiveTo explore the endoscopic and pathological features of colorectal serrated lesion.Methods The detection rate, endoscopic and pathological data of colorectal serrated lesion patients, diagnosed in the Department of Digestive Endoscopy, Fujian Provincial Hospital from January 2006 to December 2011, were analyzed retrospectively.Results In 14403 （ 24.1%） out of 59491 patients undergoing colonoscopy, polyps were found. Among them, 78 patients with 91 colorectal serrated lesion were found , with a detection rate of 0.13%. Serrated lesion accounted for a ratio of 0.54% polyps. Among 91 cases with colorectal serrated lesion, the ratio of male to female was 1.6：1, most found in 40-69 years old, average age was 55.76 years old. More serrated lesion were single adenoma, and located in rectum and sigmoid colon, but common in ascending colon. The incidence of serrated lesion with diameter （〈10 mm） was higher obviously than that in diameter （≥10 mm）. Among them, serrated lesion with wide base and sub-pedicle were found commonly. 91 cases with serrated lesion included 68 HP（74.7%）, 9 TSA（9.9%）, and 14 SSA/P（15.4%） which 10 located in ascending colon. The pathologic examination showed 43 cases （47.3%） with pure serrated lesion, 47 cases （51.6%）with serrated lesion complicated with low grade intraepithelial neoplasia, 1case （1.1%）with serrated lesion complicated with high grade intraepithelial neoplasia.The rate of intraepithelial neoplasia in that of serrated lesion with diameter （≥10 mm） and with wide base and sub-pedicle was significant higher than in that of diameter （〈10 mm） and with pedicle.Conclusions Colorectal serrated lesion has the common characters of neoplastic polyps. Colorectal serrated lesion with diameter （≥10 mm） and with wide base, sub-pedicle probably complicated with differently grade intraepithelial neoplasia.