内镜下十二指肠乳头括约肌切开术与结直肠腺瘤的相关性研究

Correlation between endoscopic duodenal papillary sphincterotomy and colorectal adenoma

目的研究十二指肠乳头括约肌切开术(EST)与结直肠腺瘤的相关性。方法选取2006年1月-2018年12月于南方医科大学顺德医院行结肠镜检查的患者资料。将有十二指肠乳头切开史大于1年的患者作为EST组,按1∶2配比,选择同期行结肠镜检查但无十二指肠乳头切开史的功能性胃肠病患者作为对照组,对两组患者的结直肠腺瘤检出率、发生部位及病理类型进行统计学分析,并运用Logistic回归分析排除混杂因素的影响。结果EST大切开组结直肠腺瘤检出率与对照组比较差异有统计学意义(P=0.008);Logistic回归分析显示,EST大切开组(P=0.027)、男性(P=0.017)是结直肠腺瘤的危险因素;EST大切开组与对照组比较,腺瘤的发生部位(P=0.233)和腺瘤病理分型(P=0.926)差异均无统计学意义。结论十二指肠乳头括约肌大切开术、男性是结直肠腺瘤的危险因素,应注意此类患者结直肠腺瘤的筛查。同时,临床医生应严格把握EST适应证并选择适当的术式,尽量保护十二指肠乳头括约肌功能。

Objective To study the correlation between endoscopic duodenal papillary sphincterotomy and colorectal adenoma.Methods Clinical data of patients underwent colonoscopy from January 2006 to December 2018 were retrieved.Patients with more than 1 year of history of duodenal papillectomy were included in the observation group.In the corresponding period,functional gastrointestinal patients who underwent colonoscopy but had no history of duodenectomy were selected as the control group at the ratio of 1~2.The detection rate,location and pathological type of colorectal adenoma in the two groups were statistically analyzed,and the influence of confounding factors was excluded by Logistic regression analysis.Results The detection rate of colorectal adenoma in the EST large-incision group was significantly different from that in the control group(P=0.008).Logistic regression analysis showed that EST large incision group(P=0.027)and male(P=0.017)were the risk factors for colorectal adenoma.According to the comparison between the EST large incision group and the control group,there was no statistically significant difference between the location of adenoma(P=0.233)and the pathological classification of adenoma(P=0.926).Conclusion Duodenal papillary colorectal sphincterotomy and male are the risk factors for colorectal adenoma,therefore,the screening of adenoma in such patients should be paid attention to.At the same time,in order to protect the function of duodenal papillary sphincter as much as possible,the clinician should strictly grasp the EST indications and choose the appropriate operation.