Wireless capsule endoscopy in detecting small-intestinal polyps in familial adenomatous polyposis

AIM:To detect the prevalence of small bowel polyps by wireless capsule endoscopy(WCE)in patients with familial adenomatous polyposis(FAP).METHODS:We examined prospectively 14 patients with FAP to assess the location,size and number of small-intestinal polyps.Patients'age,sex,years of observation after surgery,type of surgery,duodenal polyps and colorectal cancer at surgery were analyzed.RESULTS:During WCE,polyps were detected in 9/14(64.3%)patients.Duodenal adenomatous polyps were found in nine(64.3%)patients,and jejunal and ileal polyps in seven(50%)and eight(57.1%),respectively.The Spigelman stage of duodenal polyposis was associated with the presence of jejunal and ileal polyps.Identification of the ampulla of Vater was not achieved with WCE.Importantly,the findings of WCE had no immediate impact on the further clinical management of FAP patients.No procedure-related complications were observed in the patients.CONCLUSION:WCE is a promising noninvasive new method for the detection of small-intestinal polyps.Further investigation is required to determine which phenotype of FAP is needed for surveillance with WCE.

Azathioprine does not reduce adenoma formation in a mouse model of sporadic intestinal tumorigenesis

AIM: To investigate if azathioprine could reduce adenoma formation in ApcMin/+, a mouse model of sporadic intestinal tumorigenesis.

Composite intestinal adenoma-microcarcinoid:An update and literature review

Composite intestinal adenoma-microcarcinoid(CIAM)is a rare intestinal lesion consisting of conventional adenoma and small,well differentiated carcinoid[microcarcinoid(MC)]at its base.The incidence of CIAM is 3.8%in surgically resected colorectal polyps.While its pathogenesis is unknown,studies support the role of Wnt/β-catenin pathway in the tumorigenesis of CIAM.CIAMs have been primarily reported in the colon wherein they present as polyps with well-defined margins,similar to conventional adenomatous polyps.MC is usually found in adenomatous polyps with high-risk features such as large size,villous architecture,or high grade dysplasia.Histologically,the MC component is often multifocal and spans 3.9 to 5.8 millimeters in size.MC is usually confined within the mucosa but occasional CIAM cases with MC extending to the submucosa have been reported.MC of CIAM demonstrates bland cytology and inconspicuous proliferative activity.The lesional cells are positive for synaptophysin and 60%to 100%of cases show nuclearβ-catenin positivity.MC poses a diagnostic challenge with its morphologic and immunohistochemical resemblance to both benign and malignant lesions,including squamous morules/metaplasia,adenocarcinoma,squamous cell carcinoma,sporadic neuroendocrine tumor and goblet cell adenocarcinoma.CIAM is an indolent lesion with a favorable outcome.Complete removal by polypectomy is considered curative.Awareness and recognition of this rare entity will help arrive at correct diagnosis and improve patient care.Currently,CIAM is not recognized as a subtype of mixed neuroendocrine-nonneuroendocrine neoplasm by WHO.

Expression of adipokine ghrelin and ghrelin receptor in human colorectal adenoma and correlation with the grade of dysplasia

BACKGROUNDGhrelin is an adipokine that plays an important role in energy balance. Expressionof ghrelin and ghrelin receptor has been investigated in different tissues andtumors. Studies regarding expression of ghrelin and ghrelin receptor in colorectaltumors are scarce and no data on expression of ghrelin and its receptor incolorectal adenomas has been published. Ghrelin and ghrelin receptor werehighly expressed in colon carcinoma cells while expression was decreased in lessdifferentiated tumors, presuming that ghrelin might be important in early phasesof tumorigenesis.AIMTo investigate the expression of ghrelin and ghrelin receptor in human colorectaladenomas and adjacent colorectal tissue.METHODSIn this prospective study (conducted from June 2015 until May 2019) we included92 patients (64 male and 28 female) who underwent polypectomy for colorectaladenomas in the Department of Gastroenterology and Hepatology, “Sestre milosrdnice” Clinical Hospital Center in Zagreb, Croatia. After endoscopicremoval of colorectal adenoma, an additional sample of colon mucosa in theproximity of the adenoma was collected for pathohistological analysis. Adenomaswere graded according to the stage of dysplasia, and ghrelin and ghrelin receptorexpression were determined immunohistochemically in both adenoma andadjacent colon tissue using the polyclonal antibody for ghrelin (ab150514,ABCAM Inc, Cambridge, United States) and ghrelin receptor (ab48285, ABCAMInc, Cambridge, United States). Categorical and nominal variables were describedthrough frequencies and proportions and the difference between specific groupswere analyzed with Fisher’s and Fisher-Freeman-Halton’s method respectively.Spearman's rank correlation coefficient was determined for correlation ofexpression of ghrelin and ghrelin receptor in adenoma and adjacent colon tissuewith the grade of adenoma dysplasia.RESULTSAmong 92 patients with colorectal adenoma 43 had adenomas with high-gradedysplasia (46.7%). High expression of ghrelin was 7 times more common in highgradeadenoma compared to low-grade adenomas (13.95% to 2.04%, P = 0.048),while the expression of ghrelin in adjacent colon tissue was low. We found nocorrelation between ghrelin receptor expression in adenoma and adjacent colontissue and the grade of colorectal adenoma dysplasia. The most significantcorrelation was found between ghrelin and ghrelin receptor expression inadenomas with high-grade dysplasia (rho = 0.519, P < 0.001).CONCLUSIONGhrelin and ghrelin receptor are expressed in colorectal adenoma and adjacenttissue with ghrelin expression being more pronounced in high grade dysplasia asa possible consequence of increased local synthesis.

Clinicopathological features and expression of regulatory mechanism of the Wnt signaling pathway in colorectal sessile serrated adenomas/polyps with different syndrome types

BACKGROUND Colorectal cancer(CRC)is the third most common cancer worldwide,with the fourth highest mortality among all cancers.Reportedly,in addition to adenomas,serrated polyps,which account for 15%-30%of CRCs,can also develop into CRCs through the serrated pathway.Sessile serrated adenomas/polyps(SSAs/Ps),a type of serrated polyps,are easily misdiagnosed during endoscopy.AIM To observe the difference in the Wnt signaling pathway expression in SSAs/Ps patients with different syndrome types.METHODS From January 2021 to December 2021,patients with SSAs/Ps were recruited from the Endoscopy Room of Shanghai Traditional Chinese Medicine-Integrated Hospital,affiliated with Shanghai University of Traditional Chinese Medicine.Thirty cases each of large intestine damp-heat(Da-Chang-Shi-Re,DCSR)syndrome and spleen-stomach weakness(Pi-Wei-Xu-Ruo)syndrome were reported.Baseline comparison of the general data,typical tongue coating,colonoscopy findings,and hematoxylin and eosin findings was performed in each group.The expression of the Wnt pathway-related proteins,namelyβ-catenin,adenomatous polyposis coli,and mutated in colorectal cancer,were analyzed using immunohistochemistry.RESULTS Significant differences were observed with respect to the SSAs/Ps size between the two groups of patients with different syndrome types(P=0.001).The other aspects did not differ between the two groups.The Wnt signaling pathway was activated in patients with SSAs/Ps belonging to both groups,which was manifested asβ-catenin protein translocation into the nucleus.However,SSAs/Ps patients with DCSR syndrome had more nucleation,higherβ-catenin expression,and negative regulatory factor(adenomatous polyposis coli and mutated in colorectal cancer)expression(P<0.0001)than SSA/P patients with Pi-Wei-Xu-Ruo syndrome.In addition,the SSA/P size was linearly correlated with the related protein expression.CONCLUSION Patients with DCSR syndrome had a more obvious Wnt signaling pathway activation and a higher risk of carcinogenesis.A high-quality colonoscopic diagnosis was essential.The thorough assessment of clinical diseases can be improved by combining the diseases of Western medicine with the syndromes of traditional Chinese medicine.

Cumulative incidence and risk factors for pouch adenomas associated with familial adenomatous polyposis following restorative proctocolectomy

BACKGROUND The emergence of restorative total proctocolectomy has significantly reduced the lifetime colorectal cancer risk associated with familial adenomatous polyposis(FAP).However,adenomas may develop in the ileal pouch over time and may even progress to carcinoma.We evaluated the cumulative incidence,time to development,and risk factors associated with ileal pouch adenoma.AIM To evaluate the cumulative incidence,time to development,and risk factors associated with pouch adenoma.METHODS In this retrospective,observational study conducted at a tertiary center,95 patients with FAP who underwent restorative proctocolectomy at our center between 1989 and 2018 were consecutively included.The mean follow-up period was 88 mo.RESULTS Pouch adenomas were found in 24(25.3%)patients,with a median time of 52 mo to their first formation.Tubular adenomas were detected in most patients(95.9%).There were no high-grade dysplasia or malignancies.Of the 24 patients with pouch adenomas,13 had all detected adenomas removed.Among the 13 patients who underwent complete adenoma removal,four(38.5%)developed recurrence.Among 11(45.8%)patients with numerous polyps within the pouch,seven(63.6%)exhibited progression of pouch adenoma.The cumulative risks of pouch adenoma development at 5,10,and 15 years after pouch surgery were 15.2%,29.6%,and 44.1%,respectively.Severe colorectal polyposis(with more than 1000 polyps)was a significant risk factor for pouch adenoma development(hazard ratio,2.49;95% confidence interval:1.04-5.96;P=0.041).CONCLUSION Pouch adenomas occur at a fairly high rate in association with FAP after restorative proctocolectomy,and a high colorectal polyp count is associated with pouch adenoma development.

Adult duodenal intussusception with horizontal adenoma: A rare case report

BACKGROUND Adult duodenal intussusception rarely occurs,and the majority of duodenal adenomas are located in the descending part of the duodenum.Therefore,adenomas in the horizontal part of the duodenum presenting as duodenal intussusception in adults are extremely rare.CASE SUMMARY A 36-year-old man complained of abdominal pain for 13 d.Blood analysis showed anemia.Magnetic resonance cholangiopancreatography and computed tomography revealed a tumor in the horizontal part of the duodenum as the main finding,leading to duodeno-duodenal intussusception.No obvious abnormalities were found on endoscopy or upper gastrointestinal radiography.He was diagnosed with duodenal intussusception secondary to duodenal adenoma.Laparotomy showed duodeno-duodenal intussusception and a tumor in the horizontal part of the duodenum near the ascending part.Postoperative pathology revealed tubular-villous adenoma with low-grade glandular intraepithelial neoplasia(local high-grade intraepithelial neoplasia).He was discharged without complications.CONCLUSION This case highlights that rational use of computed tomography,magnetic resonance cholangiopancreatography,endoscopy and upper gastrointestinal radiography for preoperative diagnosis and timely surgery is an effective strategy for the treatment of adult duodenal intussusception with duodenal masses.

Characterizing the composition of intestinal microflora by 16S rRNA gene sequencing

BACKGROUND This study determined the composition and diversity of intestinal microflora in patients with colorectal adenoma(CRA),which may provide precedence for investigating the role of intestinal microflora in the pathogenesis of colorectal tumors,the composition of intestinal microflora closely related to CRA,and further validating the possibility of intestinal flora as a biomarker of CRA.AIM To study the relationship between intestinal microflora and CRA.METHODS This is a prospective control case study from October 2014 to June 2015 involving healthy volunteers and patients with advanced CRA.High-throughput sequencing and bioinformatics analysis were used to investigate the composition and diversity of intestinal microflora in 36 healthy subjects and 49 patients with advanced CRA.Endpoints measured were operational taxonomic units of intestinal flora,as well as their abundance and diversity(αandβtypes).RESULTS In this study,the age,gender,body mass index,as well as location between controls and patients had no significant differences.The mucosa-associated gut microbiota diversity and bacterial distribution in healthy controls and colorectal adenomas were similar.The operational taxonomic unit,abundance,andαandβdiversity were all reduced in patients with CRA compared to controls.At the phylum level,the composition of intestinal microflora was comparable between patients and controls,but the abundance of Proteobacteria was increased,and Firmicutes and Bacteroides were significantly decreased(P<0.05).The increase in Halomonadaceae and Shewanella algae,and reduction in Coprococcus and Bacteroides ovatus,could serve as biomarkers of CRA.High-throughput sequencing confirms the special characteristics and diversity of intestinal microflora in healthy controls and patients with CRA.CONCLUSION The diversity of intestinal microflora was decreased in patients with CRA.An increase in Halomonadaceae and Shewanella algae are markers of CRA.

Clinical features of gastric adenoma detected within 3 years after negative screening endoscopy in Korea

Background:Early detection and management of gastric adenoma are important for preventing gastric cancer.The present study aimed to evaluate the predictors of missed gastric adenoma on screening endoscopy in Korea and identify the risk factors associated with interval precancerous gastric lesions.Methods:All cases of gastric adenomas diagnosed via screening endoscopy between 2007 and 2019 were reviewed.Among them,those who had undergone endoscopy within 3 years were included in the present study.Missed gastric adenoma was defined as gastric adenoma diagnosed within 3 years after negative screening endoscopy.Results:In total,295 cases of gastric adenoma were identified.Of these,95(32.2%)were missed gastric adenoma cases(mean age,60.6 years;average interval between final and index endoscopies,12.6months);the remaining 200(67.8%)were newly detected adenoma cases.Univariate analysis revealed thatmale sex,endoscopist experience,observation time,and presence of gastric intestinalmetaplasia(pathologically proven)were associated with missed gastric adenoma.Multivariate analysis revealed that gastric intestinal metaplasia(odds ratio[OR],2.736;95%confidence interval[CI],1.320–5.667;P=0.007)and shorter observation time of the index screening endoscopy(B,0.011;OR,0.990;95%CI,0.986–0.993;P<0.001)were independent risk factors for missed gastric adenoma.The optimal cut-off for the observation time for detecting gastric adenoma was 3.53minutes(area under curve,0.738;95%CI,0.677–0.799;P<0.001).Conclusions:Gastric intestinal metaplasia is an indication of missed gastric adenoma.Therefore,careful inspection of gastric mucosa with gastric intestinal metaplasia and proper observation time can lower the possibility of missing the gastric adenoma during screening.

Identification of differentially expressed genes in normal mucosa,adenoma and adenocarcinoma of colon by SSH

AIM: To construct subtracted cDNA libraries and further identify differentially expressed genes that are related to the development of colorectal carcinoma(CRC). METHODS: Suppression subtractive hybridization(SSH) was done on cDNAs of normal mucosa, adenoma and adenocarcinoma tissues from the same patient. Three subtracted cDNA libraries were constructed and then hybridized with forward and backward subtracted probes for differential screening. Positive clones from each subtracted cDNA library were selected for sequencing and BLAST analysis. Finally, virtual Northern Blot confirmed such differential expression. RESULTS: By this way, there were about 3-4 X 10(2) clones identified in each subtracted cDNA library, in which about 85% positive clones were differentially screened. Sequencing and BLAST homology search revealed some clones containing sequences of known gene fragments and several possibly novel genes showing few or no sequence homologies with any known sequences in the database. CONCLUSION: All results confirmed the effectiveness and sensitivity of SSH. The differentially expressed genes during the development of CRC can be used to shed light on the pathogenesis of CRC and be useful genetic markers for early diagnosis and therapy.

菊藻丸预防湿热瘀阻型大肠腺瘤性息肉术后复发40例疗效观察

目的:探究菊藻丸对大肠腺瘤性息肉内镜切除术后复发的预防效果。方法:选取80名大肠息肉患者,采用随机单盲法,将其随机分为治疗组和对照组,每组各含40名患者。所有患者息肉切除术后常规予内科止血、抗感染、营养支持等基础治疗1天,观察组在一般治疗的基础上,在术后第15天开始服用菊藻丸治疗,疗程为3个月;对照组除了一般基础治疗外,不做任何干预治疗。比较两组术前及术后治疗后临床症状积分,观察并记录两组术后半年、1年息肉复发情况。结果:观察组各临床症状(腹痛腹胀、排便不爽、腹泻、便血、口苦以及舌苔黄腻)的评分均显著低于对照组,差异具有统计学意义(P<0.05);术后6个月及1年随访,观察组息肉复发情况均低于对照组,差异具有统计学意义(P<0.05)。结论:菊藻丸能改善内镜切除术后的大肠腺瘤性息肉患者的临床症状及降低腺瘤性息肉的复发率。

肠道菌群检测在结直肠腺瘤和结直肠癌诊断中的价值

目的探讨人类粪便肠道菌群对结直肠腺瘤(CRA)及结直肠癌(CRC)的诊断价值。方法横断面研究选取2020年10月至2022年10月浙江大学医学院附属邵逸夫医院收治的行结肠镜检查患者160例。其中经外科手术后病理学检查确诊为CRC者55例(CRC组);经结肠镜检查提示结直肠息肉,并经息肉切除后病理学检查确诊CRA者55例(CRA组);经结肠镜检查未见异常的健康者50名(HC组)。采用实时荧光定量核酸扩增检测(qPCR)方法对研究对象肠道准备前粪便标本特定菌群进行相对定量检测。比较3组研究对象肠道菌群[双歧杆菌属(Bb)、乳酸杆菌属(Lb)、产肠毒素脆弱拟杆菌(ETBF)、具核梭杆菌(Fn)、厌氧消化链球菌(P anaerobius)]相对定量;分析肠道菌群相对定量对CRC和CRA的诊断效能。结果3组研究对象肠道ETBF相对定量比较差异无统计学意义(P>0.05),而Bb、Lb、Fn、P anaerobius相对定量比较差异均有统计学意义(均P<0.05),CRC组Bb、Fn、P anaerobius相对定量>CRA组>HC组(均P<0.05),CRA组Lb相对定量>CRC组>HC组(均P<0.05)。ROC曲线分析显示,单细菌P anaerobius对CRA和CRC的诊断效能最好;联合细菌Fn+Lb+P anaerobius对CRA和CRC的诊断效能最好;细菌联合实验室检查中Fn+Lb+P anaerobius+大便隐血实验+癌胚抗原检测对CRA和CRC的诊断效能最好。结论肠道菌群P anaerobius定量检测在CRA和CRC诊断中的有重要价值;Fn+Lb+P anaerobius联合大便隐血实验及癌胚抗原检测可提高CRA和CRC的检出率。

人工智能肠镜辅助诊断肠道腺瘤的价值

目的探究人工智能肠镜(肠镜AI)辅助诊断肠道腺瘤的价值。方法选取512例疑似肠道腺瘤患者作为研究对象,所有研究对象均行普通肠镜、肠镜AI辅助诊断和病理组织切片活检。比较普通肠镜与肠镜AI联合普通肠镜诊断肠道腺瘤的效能。结果在512例疑似肠道腺瘤患者中,445例病理组织切片活检结果为肠道腺瘤。肠镜AI联合普通肠镜检查诊断肠道腺瘤的灵敏度、特异度、准确度均高于普通肠镜检查(97.98%比90.34%,92.54%比61.19%,97.27%比86.52%,均P<0.05)。肠镜AI联合普通肠镜检查对腺瘤的病理分型与病理组织切片活检一致的病例数为428例,普通肠镜检查对腺瘤的病理分型与病理组织切片活检一致的病例数为390例(96.18%比87.64%,P<0.05)。445例肠道腺瘤患者中,19例病理组织检查结果为恶性肠道腺瘤,肠镜AI联合普通肠镜检查诊断恶性肠道腺瘤的特异度和准确度均高于普通肠镜检查(96.95%比93.66%,95.96%比91.91%,均P<0.05)。结论肠镜AI联合普通肠镜诊断肠道腺瘤的灵敏度、特异度、准确度和对肠道腺瘤病理分型的判定情况均显著优于普通肠镜,可提高恶性肠道腺瘤病变的检出率,具有较高的临床应用价值。

人工智能肠镜辅助诊断技术诊断肠道腺瘤的价值及其影响因素分析

目的:探讨人工智能肠镜辅助诊断技术诊断肠道腺瘤的临床效果,并分析其影响因素。方法:回顾分析2019年5月至2020年5月接受肠镜相关检查的436例患者的临床资料,分为接受常规肠镜检查的对照组(n=203)与接受人工智能肠镜辅助诊断的观察组(n=233),比较两组肠道腺瘤检出率,并评估透明帽使用、肠道清洁程度、操作者经验等因素对腺瘤检出率的影响。结果:对照组与观察组分别检出腺瘤81例与143例,检出率为39.90%与61.37%,差异有统计学意义(P<0.05)。与经验不足的医师相比,对照组与观察组肠镜检查经验超过1000例的医师腺瘤检出率更高(P<0.05);观察组在肠镜镜头处安装透明帽对于隐藏于褶皱处的凸起腺瘤具有更好的检出效果(P<0.05);腺瘤检出率与患者性别、年龄并无显著相关性。结论:利用人工智能肠镜辅助诊断技术可提高临床肠道腺瘤检出率,透明帽的使用、经验较丰富的医师有助于肠道腺瘤的检出。

基于“湿热理论”运用新加三仁汤防治大肠腺瘤术后复发的临床研究

目的研究大肠腺瘤内镜治疗术后应用新加三仁汤预防术后复发的疗效。方法便利选取2022年1—12月扬州大学附属医学院如东县中医院行内镜下治疗的109例大肠腺瘤患者为研究对象,按照随机数字表法分组。对照组54例,内镜术后予以常规治疗,治疗组55例,加用新加三仁汤治疗。对比两组患者治疗1年后息肉复发情况及分别于术后1、2、6个月临床症状改善情况。结果治疗组复发发生率为16.36%,低于对照组的35.18%,差异有统计学意义(χ^(2)=5.057,P<0.05)。治疗前,两组中医证候积分各指标比较,差异无统计学意义(P>0.05);治疗后,治疗组中医证候积分均显著低于对照组,差异有统计学意义(P<0.05)。结论大肠腺瘤术后应用新加三仁汤有助于降低息肉复发率,改善患者临床症状,提高治疗效果。

大肠息肉癌变相关危险因素分析

目的探讨大肠息肉癌变的相关危险因素。方法收集该院2003～2012年行结肠镜检查的患者资料,对经病理证实为大肠息肉患者的性别、年龄、息肉的单发或多发情况、部位、大小、病理类型与癌变的关系进行分析总结。结果 2003～2012年间行肠镜检查共75 084例,检出息肉14 806例,检出率为19.72%。左半和右半大肠息肉的检出率在不同年龄段人群中差异有统计学意义(P<0.05),但全结肠息肉的检出率随年龄的增加而增高;上皮内瘤变和癌变的发生率随患者的年龄增加而增高;左半结肠息肉癌变率明显高于右半结肠(P<0.0167);息肉癌变率随其直径的增大而增高(P<0.01);各类腺瘤性息肉的癌变率均高于增生性息肉,息肉的绒毛成分愈多癌变率越高(P<0.01)。结论患者年龄、息肉的部位、大小和组织学类型是预测癌变危险性的重要指标,对年龄大于45岁、直径大于或等于1cm,特别是左半腺瘤性息肉应尽早行内镜下治疗,以防止大肠癌的发生。

保留部分前列腺的全膀胱切除术治疗浸润性膀胱癌

背景与目的:经典的根治性膀胱切除术将膀胱和前列腺全部切除,术后阳痿和尿失禁发生率高。在肿瘤没有累及前列腺的情况下,根治术中保留部分前列腺可改善术后性功能和控尿功能,但对预后是否有影响尚不清楚。本文报告10例保留部分前列腺的改良全膀胱切除术的经验,阐述改良术式对术后性功能、控尿功能和肿瘤控制的影响。方法:对10例男性浸润性膀胱癌患者,先经尿道电切除部分前列腺,全膀胱切除时保留部分前列腺包囊。下尿路重建采用肠道新膀胱术,新膀胱与残留的前列腺包囊吻合。术后随访评价肿瘤控制、尿液控制和性功能情况。结果:术后病理分期均为T2N0M0。随访3～12个月(平均9个月),9例无瘤生存,1例低分化移行细胞癌患者术后2个月出现全身骨骼及淋巴转移;全部患者自主排尿,完全控尿9例,部分控尿1例;术前有性功能的8例中,术后6例保持阴茎勃起功能。结论:保留部分前列腺的改良全膀胱切除术可以较好保留下尿路控尿功能和阴茎勃起功能,但对肿瘤控制的远期影响有待进一步观察。

白塞病合并肠道病变的临床回顾性分析

目的分析白塞病合并的肠道病变类型,为进一步诊治白塞病合并肠道病变提供参考依据。方法收集401例完成纤维结肠镜检查的白塞病患者的基本资料、肠镜、病理及血液学检查情况,对肠道病变进行统计描述,并分析不同肠道病变的部位及血液学指标的差异。结果401例白塞病患者中有肠道改变者88例(21.95%)。肠溃疡(包括活动期及愈合期)52例(12.97%),以回盲部多见,其中62.86%(占白塞病患者5.49%,22/401)未诉胃肠道相关症状。溃疡活动期炎症指标较愈合期高,其中C反应蛋白(C reactive protein,CRP)差异具有统计学意义(P=0.028)。腺瘤(包括管状腺瘤、锯齿状腺瘤、绒毛状腺瘤)33例(8.23%),以直、乙状结肠,尤其是直乙交界处最为常见;腺瘤主要发生于年龄较大者,与白塞病无肠道病变或合并溃疡者差异有统计学意义(P=0.022,0.000),天冬氨酸氨基转移酶(aspartate aminotransferase,AST)、γ-谷氨酰基转移酶(gamma-glutansferase,GGT)及尿酸(uric acid,UA)升高,临床实验室检查差异与年龄增高相关。另见2例大肠黑变病及1例盲肠憩室。结论白塞病合并肠溃疡或腺瘤占相当一部分比例,且白塞肠病或白塞病合并腺瘤患者常未诉相关症状,故行常规肠镜检查对白塞病的诊治是必要的。

大肠腺瘤癌变因素分析

目的了解大肠腺瘤癌变的危险因素,为临床诊治提供参考.方法对1992～2002年我院接受纤维结肠镜检的大肠腺瘤患者630例,有明确病理诊断的腺瘤共849枚进行回顾性分析.结果 （1）大肠腺瘤好发于直肠和乙状结肠, 直肠腺瘤的癌变率最高,比较差异有统计学意义（P〈0.05）;（2）大肠腺瘤患者好发年龄为50～79岁,随着年龄的增加腺瘤癌变率有增加的趋势,比较差异有统计学意义（P〈0.05）;（3）大肠腺瘤的组织类型中管状腺瘤最多,癌变率从高到低的顺序依次为绒毛状腺瘤、混合性腺瘤、管状腺瘤,比较差异有统计学意义（P〈0.05）;（4）大肠腺瘤随着直径的增大变得易癌变,比较差异有统计学意义（P〈0.05）;（5）大肠腺瘤具有多发性,多发性腺瘤患者较单发性腺瘤患者易发生腺瘤癌变,比较差异有统计学意义（P〈0.05）;（6）大肠腺瘤癌变的主要危险因素依次为腺瘤大小,组织类型,患者年龄.结论 （1）〉70岁患者,多发性腺瘤患者易发生腺瘤癌变;（2）绒毛状腺瘤,直肠腺瘤,直径〉2cm腺瘤易癌变;（3）大肠腺瘤癌变的主要危险因素依次为腺瘤大小、组织类型、患者年龄.

结直肠癌筛查对结直肠肿瘤早期诊断的意义

背景:我国结直肠癌(CRC)发病率和死亡率呈上升趋势,发病年龄趋于年轻化。目的:分析CRC筛查初筛阳性人群的结肠镜检查结果,探讨高危问卷联合粪便隐血试验的CRC筛查模式对于结直肠肿瘤早期诊断的意义。方法:连续纳入2013年5月—2019年10月参与上海市黄浦区社区CRC筛查,因初筛结果阳性至瑞金医院卢湾分院接受结肠镜检查的高危个体,内镜检查发现病变者取活检或摘除送病理检查。同期因排便习惯改变行结肠镜检查的患者作为对照组。分析两组结直肠肿瘤检出情况以及筛查阳性组的病变特征。结果:共1329例初筛阳性者纳入研究,结肠镜检查病变总体检出率为63.3%,CRC、息肉和腺瘤性息肉检出率分别为2.6%(34例)、60.7%(807例)和35.2%(468例),均显著高于对照组(n=22438)的43.6%、1.8%、41.5%和21.6%(P均<0.05)。筛查阳性组病变检出率男性显著高于女性(73.7%对54.2%,P<0.05),且随年龄增长呈增高趋势(P<0.05)。CRC主要分布于60~79岁年龄组,无性别分布差异,病变直径均≥1 cm;发生异型增生的腺瘤直径亦多≥1 cm,无异型增生的腺瘤以及增生性和炎性息肉直径则多<1 cm。结论:我国现阶段实行的社区CRC筛查模式可有效提高CRC及其癌前病变检出率。