结直肠息肉切除术后复发风险研究

Risk factors of polyp recurrence after colorectal polypectomy

目的探究初次肠镜检查患者的息肉特征与肠息肉复发的关系，及息肉切除术后不同时间段内复发情况。方法对2008年5月至2016年5月行肠镜息肉切除术的614例患者资料进行回顾性分析，根据患者特征和肠镜下息肉特征对患者风险进行分层，分析影响息肉复发的主要因素及患者不同时间段内复发情况。结果单因素分析中，年龄≥70岁、息肉直径≥0．5em、数目〉2枚且分布于全结肠是复发的危险因素。多因素分析显示息肉数目是复发的独立危险因素（OR=2．36，95％CI：1．06-5．25）。患者经6—87个月随访，总体复发率为58．6％（360／614），在6～24个月、〉24～36个月、〉36～48个月、〉48—87个月4个时间段内，高风险组累积复发率分别为60．1％、65．7％、80．7％、83．8％；低风险组累积复发率分别为22．7％、40．0％、53．8％、65．4％。两组患者息肉复发的累积风险差异有统计学意义（P=0．00）。结论初次肠镜检查中息肉数目是预测息肉复发的主要因素，息肉复发率随时间延长而增加，高风险组患者在息肉切除术后累积复发率高于低风险组患者。

Objective To explore the relationship between polyp features at first-time colonoscopy and the recurrence, and to analyze the risk factors of recurrence at different time points of follow-up. Methods The data of 614 patients undergoing colorectal polypectomy between May 2008 and May 2016 were retrospectively analyzed. Patients were classified into 3 groups according to the characteristics and polyp features at first-time colonoscopy. The risk factors influencing polyp recurrence at different time points during follow up were analyzed. Results Univariate analysis showed that age ≥70 years, polyp＇s diameter ≥ 0. 5 cm, the number of polyps 〉 2 and distribution throughout colon were risk factors for recurrence. In multivariate models, the number of polyps at baseline was the only significant predictor for recurrence （ OR = 2. 36,95%CI： 1.06-5.25）. All of 614 patients underwent 6-87 months surveillance colonoscopy. The total recurrence rate was 58.6% （360/614）. During four different surveillance intervals including 6-24 months, 〉 24-36 months, 〉36-48 months, and 〉48-87 months, the cumulative recurrence rate of high-risk group was 60. 1%, 65.7%, 80. 7%, and 83.8%, respectively, whereas, that of low-risk group was 22. 7%, 40. 0%, 53.8%, and 65.4%, respectively. There was a significant difference between the two groups （P = 0. 00）. Conclusion The number of initial colorectal polyps is useful for predicting the risk of polyp recurrence, and the rate of polyp recurrence during surveillance increases with the passage of time. The cumulative recurrence rate of high-risk group after polypectomy is significantly higher than that of low-risk group.