不同类型大肠锯齿状腺瘤的临床流行病学特征比较

Comparison on the Clinical Epidemiological Characteristics of Different Types of Serrated Adenomas in the Colon

目的:探讨不同类型大肠锯齿状腺瘤(SA)的发病特点及其相互关系。方法:收集我院2003-2017年经病理诊断为增生性息肉(HP)、传统锯齿状腺瘤(TSA)、广基锯齿状腺瘤(SSA)患者的临床资料,比较分析不同类型SA的发病情况及临床特点。结果:从6 820例结直肠息肉中筛选出SA 402例,其中HP 176例(43. 78%),TSA 83例(20. 65%),SSA 143例(35. 57%)。近15年来三种SA的检出率分别上升了92. 0%、50. 0%、111. 1%。SA好发于50岁以上,HP、TSA、SSA 50岁以上的患者分别占77. 27%、81. 92%、79. 72%,中位年龄分别为55岁、61岁、60岁。HP和TSA分布于直肠为主,分别占50. 57%、49. 40%,SSA以右半结肠为主,占57. 34%。HP、TSA、SSA伴高级别上皮内瘤变的比例分别为2. 84%、13. 25%、15. 38%,直径≥1. 0cm的进展性腺瘤的比例分别为10. 80%、30. 12%、40. 56%。SSA中形态表现为LST的有35例,占24. 48%,明显高于TSA和HP。结论:不同类型SA的临床特征存在一定差异,提示SA可能存在多种发病机制和多条癌变通路,各亚型的鉴别诊断需引起病理医师和内镜医师的重视。

Objective: To study the characteristics and the interrelation of different types of colorectal serrated adenomas( SA). Methods: The data from patients with pathologically confirmed hyperplastic polyp,traditional serrated adenoma or sessile serrated adenoma from our hospital during 2003-2017 was analyzed and compared. Results: 402 cases of SA were collected from 6 820 cases of colorectal adenomas,including 176 cases of HP( 43. 78%),83 cases of TSA( 20. 65%),143 cases of SSA( 35. 57%). The number of HP,TSA,SSA increased separately 92. 0%,50. 0%,111. 1% in recent 15 years. The predisposing age of SA was over 50 years old. The proportions of HP,TSA,SSA over 50 years old were respectively 77. 27%,81. 92%,79. 72% and the median ages were respectively 55,61,60. HP,TSA were mainly distributed in rectum,respectively accounting for 50. 57%,49. 40%. SSA was mainly distributed in right-sided colon,accounting for 57. 34%. The proportions of HP,TSA,SSA with high-grade epithelial neoplasia were respectively 2. 84%,13. 25%,15. 38%. The proportions of HP,TSA,SSA with hprogressive adenoma were respectively 10. 80%,30. 12%,40. 56%. 35 cases of LST were collected from 143 cases of SSA,accounting for 24. 48%,higher than of HP and TSA. Conclusion: There were some differences on characteristics in HP,TSA and SSA. It suggests that SA had different pathogenesis and cancerous pathways. The differential diagnosis of SA subtypes needs our attention.