儿童结直肠息肉临床及内镜特征分析

Analysis of clinical and endoscopic characteristics of colorectal polyps in children

分析儿童结直肠息肉的临床及内镜特征,探讨儿童结直肠息肉检出率和年龄及性别分布特征、内镜下治疗效果及随访监测,为儿童结直肠息肉的疾病管理提供参考。回顾性分析2019年1至12月在西安市儿童医院诊治的结直肠息肉患儿的临床及内镜特征。将患儿按年龄(y)分为5组:0<y<1岁、1≤y<4岁、4≤y<7岁、7≤y<12岁、12≤y≤18岁。采用独立样本t检验、Pearson卡方检验(χ^(2))比较组间差异。结果显示,2019年共完成结肠镜检查724人,共诊断结直肠息肉160人,结直肠息肉检出率为22.10%。结直肠息肉患儿中,男性105人,占65.62%,女性55人,占34.38%。男性结直肠息肉检出率22.68%,女性结直肠息肉检出率21.08%,男性结直肠息肉检出率与女性结直肠息肉检出率差异无统计学意义(χ^(2)=0.25,P=0.617)。结直肠息肉患儿在1≤y<4岁年龄段最多见,为72人,占41.14%(72/175),各年龄组结直肠息肉检出率差异有统计学意义(χ^(2)=73.929,P<0.05)。结直肠息肉患儿主要就诊症状为便血,占87.5%(140/160)。结直肠息肉以单发息肉为主,共140人,占87.50%,2~4枚息肉15人,占9.38%,5枚及以上息肉5人,占3.12%。共切除的210枚息肉,其发生部位以直肠最多见,共123枚,占58.57%(123/210)。其直径以1~2 cm最多,共111枚,占52.86%(111/210)。其山田分型以Ⅲ型为主,共114枚,占54.29%(114/210)。直径≥0.5 cm的息肉中有165枚采用内镜下黏膜切除术切除,占78.57%(165/210)。术后并发症共23人,包括:便血、腹痛、发热、呕吐、腹泻、头晕,无消化道穿孔病例。病理类型以幼年性息肉为主,共141人,占88.13%(141/160)。对幼年性息肉患儿进行3~30个月的随访,其中2例考虑有复发的可能。综上,1≤y<4岁儿童结直肠息肉检出率较高,以便血为主要临床表现,规范化的内镜下治疗及随访监测对结直肠息肉患儿至关重要。

To analyze the clinical and endoscopic characteristics of colorectal polyps in children,and to explore the detection rate,age and gender distribution characteristics,endoscopic treatment effect and follow-up monitoring of colorectal polyps in children,so as to provide reference for disease management of colorectal polyps in children.The clinical and endoscopic characteristics of children with colorectal polyps in Xi′an Children′s Hospital from January 2019 to December 2019 were retrospectively analyzed.The patients were divided into 5 groups according to age(y):0<y<1 years,1≤y<4 years,4≤y<7 years,7≤y<12 years,and 12≤y≤18 years.Independent sample t test,Pearson Chi-square test(χ^(2))were used to compare groups′differences.The results showed that a total of 724 colonoscopies were completed in 2019,and 160 colorectal polyps were diagnosed,with a detection rate of 22.10%.Among the children with colorectal polyps,105 were males,accounting for 65.62%,and 55 were females,accounting for 34.38%.The detection rate of male colorectal polyps was 22.68%,and the detection rate of female colorectal polyps was 21.08%.There was no significant difference in the detection rate of colorectal polyps between males and females(χ^(2)=0.25,P=0.617).Children with colorectal polyps were most common in the age group of 1≤y<4 years,72 cases,accounting for 41.14%(72/175).The detection rate of colorectal polyps in different age groups was statistically significant(χ^(2)=73.929,P<0.05).The main symptom of children with colorectal polyps was hematochezia,accounting for 87.5%(140/160).Colorectal polyps were mainly single polyps in 140 patients,accounting for 87.50%,15 patients had 2-4 polyps,accounting for 9.38%,and 5 patients had 5 or more polyps,accounting for 3.12%.A total of 210 polyps were removed,and the most common site of polyps was rectum,123 polyps,accounting for 58.57%(123/210).111(52.86%,111/210)of them were 1 cm to 2 cm in diameter.The Yamada classification was mainly typeⅢ,114 pieces,accounting for 54.29%(114/210).Among the 210 polyps with diameter≥0.5 cm,165 were removed by endoscopic mucosal resection,accounting for 78.57%(165/210).There were 23 patients with postoperative complications,including hematochezia,abdominal pain,fever,vomiting,diarrhea,dizziness,and no gastrointestinal perforation.Juvenile polyps were the main pathological type,accounting for 88.13%(141/160).The children with juvenile polyps were followed up for 3-30 months,and recurrence was considered in 2 of them.In conclusion,the detection rate of colorectal polyps in children aged 1≤y<4 years is high,and hematochezia is the main clinical manifestation.Standardized endoscopic treatment and follow-up monitoring are very important for children with colorectal polyps.