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 polypectomy

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 :①电切前后的病理来源于同一息肉 ;②对多次电切病例只取第一次进入病例分析 ;③多发息肉患者取第一枚电切息肉入组 ,其余排除 ;④去除电切前活检已有癌变的病例。结果 在 2 2 0例中符合要求的共 12 0例 ,年龄 5 9 8± 13 3岁 ,其中男性占 65 8% ;活检和电切病理诊断不符合率为 3 3 3 % (4 0 / 12 0 ) (P <0 0 1) ;活检和电切分别诊断腺瘤性息肉 88例 (73 3 % )和 10 0例 (83 3 % ) ,其中不典型增生分别有 2 9例 (3 3 0 % )和 46例 (4 6 0 % ) (P <0 1) ;电切后发现 5例腺瘤性息肉癌变 ,占 5 % (5 / 10 0 ) ,全部来源于 2 7例绒毛状腺瘤 (占其中 18 5 % ) ;活检诊为炎性的息肉和增生性息肉的病例 ,电切后分别有 60 % (15 / 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 5 8cm ,其余各型息肉直径均在 1cm左右 ;癌变息肉直径最大 ,达 1 8± 0 5 7cm ,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 。

Objective Compared pathological status of colorectal polyps between before and after polypectomy Methods Analysed retrospectively cases accepting polypectomy of colorectal polyps from 1997 to 2001 in our hospital,reviewing their colonoscopic reports and pathological diagnosis before and after polypectomy Every case must be required:①Pathological data came from the same polyp of before and after polypectomy;②Only enrolled the first time data if the same patient had several times of polypectomy;③Only enrolled the first removed polyp in patient with multiple polyps;④Excluded malignant polyps diagnosed by biopsy before polypectomy Results 120 patients were eligible,age 59 8±13 3 years old,79(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%) inflammatory polyps diagnosed by biopsy and 4 of 7 hyperplastic polyps diagnosed by biopsy were diagnosed as the other types of polyps by polypectomy Polypectomy diagnosed 2 juvenile polyps,2 mesenchymoma and 1 leiomyoma,which had not been found by biopsy The average diameter of villous polyps was 1 43±0 58 cm,it was bigger than all of other types of polyps,which were about 1 cm The average diameter of malignant polyps was 1 8±0 57 cm,the minimum of them was 1 cm Conclusions Pathological difference exist significantly between before and after polypectomy Biopys 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 1 cm,it benefit from finding early colorectal cancer Precaution should be paid to inflammatory polyps and hyperplastic polyps diagnosed by biopsy It is difficult for biopsy to diagnose juvenile polyps,mesenchymoma and leiomyoma