大肠息肉癌变病理类型、结肠镜诊疗特点及与患者发病年龄间的关系分析

Pathological Types, Characteristics of Colonoscopy Diagnosis and Treatment of Canceration of Colorectal Polyps and Relationship with Age of Onset

目的:探讨大肠息肉癌变病理类型、结肠镜诊疗特点及与患者发病年龄间的关系。方法:选取2019年1-12月在本院接受治疗的300例大肠息肉患者为研究对象,调查并记录所有患者的临床表现及病理诊断情况,并分析与患者发病年龄之间的关系。结果:300例大肠息肉患者主要以腹胀腹痛、便血以及大便改变为临床表现,且不同性别的发生率比较,差异均无统计学意义(P>0.05)。300例大肠息肉患者,病理检查显示发生息肉癌变56例,癌变发生率为18.7%,其中男性癌变患者43例,占76.8%,女性癌变者13例,占23.2%,男性患者大肠息肉癌变率高于女性,差异有统计学意义(P<0.05)。所有大肠息肉癌中直肠癌16例,占28.6%,升结肠14例,占25.0%,乙状结肠10例,占17.9%,其余16例,占28.6%。癌变组息肉大于非癌变组,癌变组菜花样或分叶状、绒毛管状瘤以及绒毛状腺癌的发生率均高于非癌变组,炎性息肉发生率低于非癌变组,差异均有统计学意义(P<0.05);两组带蒂情况比较,差异无统计学意义(P>0.05)。≥65岁患者大肠息肉癌变率为35.9%,显著高于<65岁患者的11.1%,差异有统计学意义(P<0.05)。结论:大肠息肉发生癌变情况与其息肉大小、形态等有关,且男性患者大肠息肉癌变率高于女性,此外,≥65岁患者的发病率相对较高,大多数大肠息肉经内镜切除术均可得到有效治疗,即便存在癌变,若其病变范围未超过黏膜层且蒂柄部无浸润,也可行内镜切除术,对于存在早期病变者经内镜切除后应进行密切随访即可,无须采用经腹部手术治疗,从而降低对机体的损伤。

Objective:To investigate the pathological types,the characteristics of colonoscopy diagnosis and treatment of canceration of colorectal polyps,and the relationship with the age of onset.Method:A total of 300 patients with colorectal polyps who received treatment in our hospital from January 2019 to December 2019 were selected as the research subjects.The clinical manifestations and pathological diagnosis of all patients were investigated and recorded,and the relationship between them and the age of onset was analyzed.Result:The main clinical manifestations of 300 patients with colorectal polyps were abdominal distension,abdominal pain,hematochezia and stool changes,and there were no significant differences in the incidence of different genders (P>0.05).Among 300 patients with colorectal polyps,pathological examination showed that 56 cases had polyp canceration,and the incidence of canceration was 18.7%,including 43 cases of male canceration,accounting for 76.8%,and 13 cases of female canceration,accounting for 23.2%.The canceration rate of colorectal polyps in male patients was higher than that in female patients,the difference was statistically significant (P<0.05).Among all colorectal polyp cancers,there were 16 cases of rectal cancer,accounting for 28.6%,14 cases of ascending colon,accounting for 25.0%,10 cases of sigmoid colon,accounting for 17.9%,and the other 16 cases,accounting for 28.6%.Polyps in the cancerous group were larger than those in the non cancerous group,the incidence of vegetable pattern or lobulated,villous tubular adenoma and villous adenocarcinoma in the cancerous group were higher than those in the non cancerous group,and the incidence of inflammatory polyps was lower than that in the non cancerous group,the differences were statistically significant (P<0.05).Comparison of pedicle condition between two groups,there was no significant difference (P>0.05).The cancer rate of large intestine polyps in patients ≥65 years old was 35.9%,significantly higher than 11.1% in patients <65 years old,the difference was statistically significant (P<0.05).Conclusion:The incidence rate of colorectal polyps is related to the size and shape of polyps.The incidence of colorectal polyps in male patients is higher than that in females.In addition,the incidence of patients ≥65 years old is relatively high.Most colorectal polyps can be effectively treated by endoscopic resection.Even if there is canceration,endoscopic resection is feasible if the lesion does not exceed the mucosa and the pedicle is not infiltrated.Patients with early lesions should be closely followed up after endoscopic resection without abdominal surgery,so as to reduce the damage to the body.