儿童结直肠息肉临床特征分析

Analysis of clinical characteristics of colorectal polyps in children

目的探讨儿童结直肠息肉的临床特点及内镜下息肉切除的有效性和安全性。方法选取2018年1月至2022年12月于首都儿科研究所附属儿童医院经结肠镜检查确诊为结直肠息肉的患儿,回顾性分析其临床资料及诊疗经过。将患儿进一步按年龄分为婴幼儿组(<3岁)、学龄前儿童组(3~6岁)、学龄期儿童组(>6岁),比较不同年龄组患儿的临床资料。结果278例患儿中,男168例,女110例;年龄10月龄至15岁,平均(4.7±3.0)岁,婴幼儿组、学龄前儿童组、学龄期儿童组分别有70、144、64例;主要症状为便血(93.9%,261/278)、腹痛(10.4%,29/278)、腹泻(1.4%,4/278);68例(24.5%,68/278)患儿内镜下可见结肠炎改变;4例合并贫血,包括1例重度贫血、1例中度贫血、2例轻度贫血;3例并发肠套叠;以单发息肉为主(95.0%,264/278),2个息肉者3例,3个及以上息肉者11例;息肉位于直肠119例、乙状结肠101例、降结肠20例、横结肠25例、升结肠3例,另有10例儿童的息肉分布在多个肠段。病理分型显示幼年性息肉266例,腺瘤性息肉3例,炎性息肉8例,增生性息肉1例。黑斑息肉综合征5例,基因检测提示STK11杂合突变3例,STK11基因exon1-9杂合缺失2例。有1例家族性腺瘤性息肉病基因检测提示APC基因截短性变异。内镜切除方式以圈套器切除术和内镜黏膜切除术为主。有11例发生并发症,包括5例出血,6例腹痛,经治疗后均痊愈,无消化道穿孔等严重并发症。学龄期儿童组中男性患儿、息肉位于多个肠段、多发息肉比例最高,学龄前儿童组中腹痛发生率最高,婴幼儿组中便血和内镜下可见结肠炎改变的发生率最高,差异均有统计学意义(P<0.05)。结论结直肠息肉高发于学龄前儿童,以幼年性息肉为主。结肠镜检查在明确诊断的同时可进行内镜下切除,安全有效。

Objective To investigate the clinical characteristics of colorectal polyps in children and the effectiveness and safety of endoscopic polypectomy.Method The clinical and endoscopic characteristics of children with colorectal polyps from January 2018 to December 2022 were retrospectively analyzed.Further divide the children into infant group(<3 years old),preschool group(3-6 years old),and school-age group(>6 years old)according to their age,and compare the clinical data of children of different ages.Result Among the 278 children,there were 168 males and 110 females.The age range was from 10 months to 15 years old,with an average of(4.7±3.0)years old.There were 70 cases in the infant group,144 cases in the preschool group,and 64 cases in the school-age group.Hematochezia was the main symptom(261 cases,93.9%),and other symptoms included recurrent abdominal pain(29 cases,10.4%)and diarrhea(4 cases,1.4%).68 cases(24.5%,68/278)of pediatric patients showed changes in colitis under endoscopy.4 cases of concurrent anemia,1 case of severe anemia,1 case of moderate anemia,2 cases of mild anemia.And 3 cases of concurrent intussusception.There were 264 cases(95.0%)of single polyp,3 cases of 2 polyps and 11 cases of 3 or more polyps.119 cases were located in the rectum,101 cases in the sigmoid,20 cases in the descending colon,25 cases in the transverse colon,3 cases in the ascending colon,and 10 cases in the more than 2 intestinal segments.Pathological analysis showed that 266 cases were juvenile polyps,3 were adenomatous polyps,8 were inflammatory polyps,and 1 was hyperplastic polyp.Heterozygous mutations of STK11 were detected in 3 of 5 patients with JPS,and STK11 exon 1-9 heterozygous deletions were detected in the other 2 patients.1 case of FAP showed truncated mutation of APC gene.The main endoscopic resection methods were snare polypectomy and EMR.Complications occurred in 11 cases,including bleeding in 5 cases and abdominal pain in 6 cases,all of which were cured after treatment,and no serious complications such as digestive tract perforation was found.The male children in the school-age group had the highest proportion of polyps located in multiple intestinal segments and multiple polyps.The preschool group had the highest incidence of abdominal pain,while the infant group had the highest incidence of rectal bleeding and colitis changes observed under endoscopy,with statistical significance(P<0.05).Conclusion Colorectal polyps were most common in preschool children,while most of them were juvenile polyps.Colonoscopy was safe and effective for the diagnosis and treatment of intestinal polyp.