老年人与中青年人大肠息肉临床特点对比研究

A comparative study on the clinical characteristics of colorectal polyps between the elderly people and young and middle-aged people

目的探索老年人大肠息肉的临床特征。方法收集在上海中医药大学附属曙光医院2006年1月-2019年12月行电子结肠镜检查并且病理证实为大肠息肉的患者1000例,进行回顾性研究,按年龄分为老年组576例,中青年组424例。统计分析老年大肠息肉患者的临床症状、息肉大小、形态、部位、数目、息肉病理分型及其与息肉癌变的相关性,同时与中青年组比较。结果老年组最常见的临床表现为便血或粪隐血阳性(48.1%)及腹胀(45.8%),中青年组主要表现为腹胀(26.7%)和便秘(25.7%);2组患者均以无蒂、多发息肉多见,左半结肠是息肉好发部位;2组均以<2 cm的息肉多见;老年组≥2 cm的息肉多于中青年组(6.2%vs 3.6%,P=0.008);2组病理分型均以管状腺瘤为主,老年组管状绒毛状腺瘤比例高于中青年组(12.6%vs 7.6%,P=0.000);癌变率男女性间无差异;老年组息肉癌变率高于中青年组(9.7%vs 4.7%,P=0.004),左半结肠息肉、无蒂息肉、绒毛状腺瘤、>2 cm息肉癌变率高;老年组<2 cm息肉癌变率高于中青组(2.4%vs 1.0%,P=0.014)。结论腹胀、便血或粪隐血阳性是老年大肠息肉患者常见临床表现,老年患者大肠息肉癌变率高于中青年患者,大肠息肉的癌变率与年龄、息肉大小、部位、病理分型密切相关。

Objective To explore the clinical characteristics of colorectal polyps in the elderly.Methods A total of 1000 patients who were diagnosed as colorectal polyps by endoscopy and confirmed by pathological examination in Shuguang Hospital from January 2006 to December 2019 were collected for retrospective study.They were divided into elderly group(576 cases)and young and middle-aged group(424 cases)according to age.The clinical symptoms,polyp size,shape,location,number,pathological classification of polyps and their correlation with canceration of polyps in elderly patients were statistically analyzed,and compared with the young and middle-aged group.Results The most common clinical manifestations of the elderly group were hematochezia or fecal occult blood(48.1%)and abdominal distension(45.8%),while the main clinical manifestations of the young and middle-aged group were abdominal distension(26.7%)and constipation(25.7%).No pedicle and multiple polyps were common in both groups.The left half colon was the most common site of polyps.Polyps less than 2 cm were common in both groups.The number of polyps≥2 cm in the elderly group was more than that in the young and middle-aged group(6.2%vs 3.6%,P=0.008).The pathological types of polyp in the two groups were mainly tubular adenomas,the proportion of tubular villous adenomas in the elderly group was higher than that in the young and middleaged group(12.6%vs 7.6%,P=0.000).There was no difference in the canceration rate between male and female.The incidence of polyp cancerization in the elderly group was higher than that in the young and middle-aged group(9.7%vs 4.7%,P=0.004).The canceration rate of polyps which were located in the left colon,≥2 cm in size,villous adenoma and without pedicle was higher in the elderly group.The cancerization rate of polyps<2 cm in the elderly group was higher than that in the young and middle-aged group(2.4%vs 1.0%,P=0.014).Conclusion Abdominal distension,hematochezia or fecal occult blood are common clinical manifestations in elderly patients with colorectal polyps.The canceration rate of colorectal polyps in elderly patients is higher than that in young and middle-aged patients.The canceration rate of colorectal polyps is closely related to age,polyp size,location and pathological classification.