大肠息肉电切前活检与电切后的临床病理比较

PATHOLOGICAL COMPARISON OF COLORECTAL POLYPS BETWEEN BEFORE AND AFTER POLYPECTOM Y

目的 :比较大肠息肉电切前活检与电切后息肉组织的临床病理状况。方法 :回顾 5年间在我院接受大肠息肉电切的病例 ,对比分析每一病例电切前、后的临床报告及病理诊断 ,要求 :电切前后的病理来源于同一息肉 ;对多次电切病例只取第 1次进入病例分析 ;多发息肉患者取第 1枚电切息肉入组 ,其余排除 ;去除电切前活检已有癌变的病例。结果 :在 2 2 0例病例中符合要求的病例共 1 2 0例 ,年龄 59.8± 1 3 .3 ,其中男性占65 .8% ;活检和电切病理诊断不符合率为 33 .3 % (40 / 1 2 0 ) (P <0 .0 1 ) ;活检和电切分别诊断腺瘤性息肉 88例(73 .3 % )和 1 0 0例 (83 .3 % ) ,其中不典型增生分别有 2 9例 (33 .0 % )和 46例 (46 .0 % ) (P <0 .1 ) ;电切后发现5例腺瘤性息肉癌变 ,占 5 % (5/ 1 0 0 ) ,全部来源于 2 7例绒毛状腺瘤 (占其中 1 8.5 % ) ;活检诊为炎性息肉和增生性息肉的病例 ,电切后分别有 60 % (1 5/ 2 5)和 4/ 7被诊断为其它息肉类型 ;电切后发现活检未曾诊断的幼年性息肉 2例、间质瘤 2例、平滑肌瘤 1例 ;绒毛状腺瘤的直径较大 ,为 1 .43± 0 .58cm ,其余各型息肉直径平均为 1cm左右 ;癌变息肉直径最大 ,达 1 .8± 0 .57cm ,其最小直径是 1cm。结论 :大肠息肉电切前后的临床病理存在较大差异 ,活检有?

Objective:Compared pathological status of colo rectal polyps between before and after polypectomy. Methods:Analysed retrospectively cases accepting polypectomy of colorectal polyps from 1997 to 2001 in our hospital, reviewing their colonosco pic reports and pathological diagnosis before and after polypectomy. Every case must be required: Pathological data came from the same polyp of before and af ter polypectomy; Only enrolled the first time data if the same patient had seve ral times of polypectomy;Only enrolled the first removed polyp in patient with multiple polyps;Excluded malignant polyps diagnosed by biopsy before polypectom y. Results:One hundred and twenty patients were eligible, age 59.8 ± 13.3 years old, 7 9(65.8%) of them were men. Pathological inconsistency was 33.3%(40/120) between biopsy and polypectomy( P <0.01). There were 88(73.3%) and 100(83. 3%) adenomatous polyp cases diagnosed by biopsy and by polypectomy respectively, which had 33.0%(29/88) and 46.0%(46/100) dysplasia cases respectively( P <0. 1). Malignant polyps were diagnosed in 5 patients among adenomatous polyp cases( 5.0%), all of them origined from 27 patients with villous polyp. 15 of 25(60%) i nflammatory polyps and 4 of 7 hyperplastic polyps diagnosed by biopsy were diag nosed as the other types of polyps by polypectomy. Polypectomy diagnosed 2 juven ile polyps, 2 mesenchymoma and 1 leiomyoma, which had not been found by biopsy . The average diameter of villous polyps was 1.43±0.58cm, it was bigger than al l of other types of polyps, which were about 1cm. The average diameter of malign ant polyps was 1.8±0.57cm, the minimum of them was 1cm.Conclusion:Pathological difference exist significantly between before and after polypectomy. Biopsy may miss malignant polyps, but it is a safe way for removal of small polyps. Polypectomy is recommended if the diameter of polyp is approximately 1cm, it benefit from finding early colorectal cancer. Pre caution should be paid to inflammatory polyps and hyperplastic polyps diagnosed by biopsy. It is difficult for biopsy to diagnose juvenile polyps,mesenchymoma and leiomyoma.