168例结直肠腺瘤性息肉内镜治疗后并发症及病理分析

Complications and Pathological Analysis of 168 Cases of Colorectal Adenomatous Polyps after Endoscopic Treatment

目的评估并了解内镜下摘除结直肠腺瘤性息肉(colorectal adenomatous polyps,CAP)的安全性及术后病理情况。方法收集2017年3月至2019年3月收治的168例CAP住院患者的临床资料。按年龄段将其分为3组:青年组(≤34岁,n=26)、中年组(35~59岁,n=101)及老年组(≥60岁,n=41),分析3组的术后并发症、息肉部位及病理类型。结果168例患者均在内镜下成功摘除息肉。17例出现出血(术中出血14例,术后迟发性出血3例)、占10.1%(17/168),均在内镜下钛夹或电凝止血成功;穿孔2例、占1.2%(2/168),原因主要是因息肉过大及切除过深;其他2组未见出血、穿孔发生,3组均未发生感染;3组并发症比较差异无统计学意义(P>0.05)。息肉发生部位:左半结肠明显多于右半结肠,位于直肠61例(36.3%,61/168)的发生率高于其他部位(P<0.05)。病理分型:青年组均为管状腺瘤;中年组管状腺瘤84例,占83.2%(84/168);老年组绒毛状腺瘤11例、占26.8%(11/168),腺瘤出现局部癌变2例、占4.9%(2/168)。老年组混合性腺瘤、绒毛状腺瘤、高级别瘤变及局部癌变比例高于其他2组(P<0.05)。结论内镜下切除CAP效果确切,术后并发症较低,病理以管状腺瘤为主,随着年龄的增长,混合性腺瘤及绒毛状腺瘤的发生比例逐渐增高。

Objective To explore the safety of endoscopic polypectomy and the postoperative pathology of colorectal adenomatous polyps(CAP).Methods The clinical data of 168 patients admitted from March 2017 to March 2019 for CAP were collected.These patients were divided into young group(≤34 years old,n=26),middle-aged group(35-59 years old,n=101)and elderly group(≥60 years old,n=41).Postoperative complications and sites and pathological types of CAP were analyzed in all the three groups.Results The polyps were successfully removed by endoscopic polypectomy.Among the 168 cases,bleeding occurred in 17 patients(10.1%,intraoperative bleeding in 14 and delayed postoperative bleeding in 3),and perforation in 2 elderly patients(1.2%).The bleeding was controlled by endoscopic titanium clip or electrocoagulation.The perforation was mainly caused by oversized polyps and excessive resection.No bleeding and perforation occurred in both young group and middle-aged group,and no infection was found in all the 3 groups.There were no significant differences in complications among the 3 groups(P>0.05).The incidence of CAP in the left side of the colon was higher than that in the right side of the colon,and that in the rectum(36.3%,61/168)was higher than that in other tissues(P<0.05).All patients in young group had tubular adenoma,84 patients(83.2%)in middle-aged group had tubular adenoma,and 11 patients(26.8%)in elderly group had villous adenoma.The adenoma experienced partial canceration in 2 patients(4.9%).The proportions of patients with mixed adenoma,villous adenoma,high-grade neoplasia and partial canceration in elderly group were higher than those in the other groups(P<0.05).Conclusion Endoscopic resection is effective for CAP and causes few postoperative complications.Tubular adenoma is the main pathological feature of CAP,and the incidence of mixed adenoma and villous adenoma gradually increases with age.