进展期结直肠腺瘤患者临床病理学特征分析

Clinicopathological characteristics analysis of patients with advanced colorectal adenoma

目的 通过对进展期结直肠腺瘤患者临床病理学特征的分析,为结直肠癌的防治提供参考。方法 回顾性总结2018年1月至2022年12月于延安大学附属医院住院的进展期(566例)及非进展期(681例)结直肠腺瘤患者1 247例(共4 503枚)的临床资料,分析两组的临床病理学特征及危险因素。结果 一般资料比较,两组在年龄方面的差异有统计学意义,进展期腺瘤组较非进展期组在≥60岁人群发病率更高(P<0.05)。合并症及服药史比较,进展期腺瘤组较非进展期组合并糖尿病的概率更高(P<0.05)。生化指标比较,进展期腺瘤组较非进展期组血清钙浓度更低、CEA更高、粪隐血阳性的概率也更高(P<0.05)。内镜表现比较,与非进展期组相比,进展期腺瘤组的腺瘤直径更大、数量更多,表面充血水肿、粗糙糜烂、分叶更多见(P<0.05)。患者年龄、吸烟、粪隐血试验阳性、合并糖尿病、低钙血症、CEA升高、腺瘤位置、腺瘤大体形态是进展期结直肠腺瘤发生的相关因素(P<0.05)。多因素分析结果显示:低钙血症(P<0.01)、CEA升高(P<0.01)、远端腺瘤(P<0.001)、亚蒂(P<0.001)、有蒂(P<0.001)是进展期腺瘤发生的独立危险因素。结论 有高危因素的进展期结直肠腺瘤人群应积极定期复查结肠镜,特别是腺瘤位于结肠远端、亚蒂、有蒂,应给予高度关注。

Objective To provide reference for the prevention and treatment of colorectal cancer by analyzing the clinical data of patients with advanced colorectal adenoma.Methods The clinical data of 1 247 patients(a total of 4 503 pieces) with advanced(566 cases) and non-advanced(681 cases) colorectal adenomas admitted to the Affiliated Hospital of Yan'an University from January 2018 to December 2022 were retrospectively summarized,and the clinical characteristics and risk factors of the two groups were analyzed.Results Compared with the general data,there was statistical difference in age between the two groups.The incidence of advanced adenoma group was higher than that of non-advanced adenoma group(P<0.05);Compared with non-progressive adenoma group,the probability of diabetes mellitus was higher in advanced adenoma group(P<0.05).Compared with the control group,the advanced adenoma group had lower serum calcium concentration,higher CEA and higher probability of positive fecal occult blood(P<0.05),and the diameter and number of adenomas in the advanced adenoma group were larger,and the surface hyperemia and edema,rough erosion and lobulation were more common(P<0.05).Age,smoking,positive fecal occult blood,diabetes mellitus,hypocalcemia,elevated CEA,adenoma location,and adenoma morphology were correlated with the occurrence of advanced colorectal adenoma(P<0.05).The results of multiple factors showed that hypocalcemia(P=0.002),elevated CEA(P=0.003),distal adenoma(P<0.001),sessile polyp(P<0.001) and pedunculated polyp(P<0.001) were independent risk factors for the development of advanced adenoma.Conclusion People with advanced colorectal adenoma with high risk factors should actively review colonoscopy regularly,especially adenomas located at the distal end of the colon,sessile polyp and pedunculated polyp should be given high attention.