上海市嘉定区2652枚结直肠息肉临床病理分析

Clinicopathological Analysis of 2652 Colorectal Polyps in Jiading District,Shanghai,China

背景:结直肠息肉特别是腺瘤性息肉为结直肠癌前病变,结肠镜检查检出并切除息肉对结直肠癌的预防具有重要意义。目的:对上海市嘉定区1 613例结直肠息肉患者进行回顾性分析,为结直肠息肉的内镜监测管理提供依据。方法:2013年1月—2014年8月上海瑞金医院北院内镜中心检出的2 652枚结直肠息肉纳入研究,对息肉临床病理特征、活检与内镜切除标本病理诊断符合率以及随访期间息肉再次检出情况进行统计分析。结果:2 652枚结直肠息肉中75.3%(1 996枚)为远端结肠息肉,腺瘤性息肉占77.5%(2 056枚),其中39.1%(804枚)发生上皮内瘤变。447枚息肉同时取活检并在切除后送病理检查,两次病理诊断总体符合率为60.4%,其中腺瘤性息肉符合率为68.1%。术后1.5年复查结肠镜再次检出息肉并送病理检查共218枚,腺瘤性息肉占74.3%,近端结肠和直径≤1.0 cm的息肉再次检出率分别显著高于远端结肠和直径>1.0 cm者(12.3%对6.9%,9.0%对4.5%,P均<0.01)。结论:腺瘤性息肉在结肠镜检查检出的息肉中占比较高;应重视息肉切除后标本的病理检查和定期随访。

Background: Colorectal polyps,especially adenomatous polyps are the precusor of colorectal cancer. Screening and polypectomy by using colonoscopy is an important approach for prevention of colorectal cancer. Aims: To conduct a retrospective analysis among 1 613 cases of patients with colorectal polyps in Jiading District,Shanghai,China for guiding the management of colonoscopy surveillance of colorectal polyps. Methods: A total of 2 652 colorectal polyps detected by colonoscopy from Jan. 2013 to Aug. 2014 in the Endoscopy Center of Shanghai Ruijin Hospital Northern Branch were recruited in the study. Clinicopathological features of the polyps,coincidence rate of biopsy pathology and polypectomy pathology,and the re-detected polyps in colonoscopic follow-up were analyzed. Results: In 2 652 colorectal polyps,1 996( 75. 3%) were located in distal colon; adenomatous polyps accounted for 77. 5%( 2 056 /2 652) of the polyps detected by colonoscopy,of which 804( 39. 1%) were found to have intraepithelial neoplasia. Both biopsy pathology and polypectomy pathology were obtained in 447 polyps,with an overall coincidence rate of 60. 4%; as for adenomas,the coincidence rate was 68. 1%. Two hundred and eighteen pathologically proved polyps were found in a 1. 5-year colonoscopic follow-up,among which 74. 3% were adenomatous polyps; the re-detection rate of polyps located in proximal colon or less than1. 0 cm in diameter was significantly higher than polyps located in distal colon and more than 1. 0 cm in diameter,respectively( 12. 3% vs. 6. 9% and 9. 0% vs. 4. 5%,P all < 0. 01). Conclusions: Adenomatous polyps account for high proportion of colorectal polyps detected by colonoscopy. Pathological examination of resection specimens and periodical follow-up are important for patients with colorectal polyps after endoscopic polypectomy.