结直肠锯齿状腺瘤或息肉的内镜表现分析

Analysis of endoscopic features for colorectal sessile serrated adenoma/polyp

目的提高广基锯齿状腺瘤或息肉（SSA/P）内镜下的诊断水平。方法收集2014年1月至2016年12月西京医院病理诊断为SSA/P的109例病例资料，与随机抽取的同期病理诊断为息肉的218例病例资料进行对比，分析内镜下表现，并对SSA/P发生及癌变的相关危险因素进行多因素分析。结果SSA/P组与息肉抽样组比较，患者平均年龄较大（P＝0.011），病变分布比较差异无统计学意义（P＝0.092）；SSA/P大体分型多为Ⅰ型和Ⅱ型，而息肉大体分型多呈Ⅰ型（P＝0.036）；SSA/P腺管开口形态呈工藤分型Ⅱ型者较多，息肉中Ⅰ型和Ⅱ型者多见（P＝0.004）；SSA/P微血管形态分型Ⅱ型较多，息肉以Ⅰ型较多（P≤0.000 1）；SSA/P表面形态更容易观察到黏液帽（P＝0.002），表面血管增粗者也更多（P＝0.004）。病理诊断方面，SSA/P相对息肉更容易异型和癌变（P＝0.001）。微血管形态分型高，表面有黏液帽和血管增粗是SSA/P发生异型或癌变的危险因素。结论SSA/P内镜下大体类型、腺管开口形态、微血管形态分型、表面结构特征和异型癌变风险与息肉存在显著性差异，较易区分。

ObjectiveTo evaluate the endoscopic features of colorectal sessile serrated adenoma/polyp（SSA/P）.MethodsThe data of 109 cases of SSA/P and 218 cases of polyps randomly selected in Xijing Hospital from January 2014 to December 2016 were collected. The endoscopic features of SSA/P and polyps were compared, and the risk factors of occurrence and cancerization of SSA/P were analyzed.ResultsThe mean age of patients in the SSA/P group was older than that of polyps group （P=0.011）. The distribution of lesions was no significant difference between the two groups （P=0.092）. The gross type of SSA/P was mainly type Ⅰ and Ⅱ, while polyps were more in type Ⅰ （P=0.036）. According to the pit pattern of Kudo, type Ⅱ was more in SSA/P, but types Ⅰ and Ⅱ were more in polyps （P=0.004）. For capillary pattern comparison, type Ⅱ was more in SSA/P, but type Ⅰ was more in polyps （P≤0.000 1）. For surface morphological features comparison, the SSA/P group was more likely to be observed the mucous cap （P=0.002） and blood vessel thickening （P=0. 004）. On pathologic diagnosis, the SSA/P group was more susceptible to atypia and carcinogenesis （P=0.001）. Higher microvascular morphological classification, being mucous cap, and blood vessel thickening were risk factors of atypia and carcinogenesis of SSA/P. Conclusion There were significant differences between SSA/P and polyps on lesion location, pit pattern, capillary pattern, surface structure characteristics, and risk factors of atypia and carcinogenesis.