舒林酸治疗家族性腺瘤性息肉病患者结直肠腺瘤的长期疗效观察  

Long-term Effects of Sulindac on Familial Adenomatous Poliposis

作　　者：李军[1] 吕愈敏[1] 顾芳[1] 李传凤[1] 张耀朋[1] 

机构地区：[1]北京大学第三医院消化科,100083

出　　处：《肿瘤防治研究》2008年第12期888-891,共4页Cancer Research on Prevention and Treatment

摘　　要：目的观察长期服用舒林酸对家族性腺瘤性息肉病(FAP)患者结直肠腺瘤消退的作用以及对结直肠中残存腺瘤组织病理学表现的影响。方法根据家族史和结肠镜检确诊FAP患者,经患者同意后每天口服舒林酸400mg。患者定期复查结肠镜评价疗效,对残存息肉进行活检病理组织学检查。结果18例FAP患者接受舒林酸长期治疗,平均维持治疗时间为(65.3±31.6)月。最后一次复查时息肉数目均较治疗前明显减少(P=0.02)。舒林酸治疗前FAP患者结直肠腺瘤活检标本中,管状腺瘤占活检腺瘤总数的86.5%,绒毛管状腺瘤占13.0%,绒毛状腺瘤占0.5%。异型程度为Ⅰ级、Ⅱ级、Ⅲ级的腺瘤分别占40.0%、43.5%和11.5%。治疗后获得的腺瘤标本中,管状腺瘤占活检腺瘤总数的97.7%,绒毛管状腺瘤占2.3%。与治疗前相比差异有统计学意义(P<0.01)。异型程度为Ⅰ级、Ⅱ级、Ⅲ级的腺瘤分别占48.9%、48.1%和3.0%,与治疗前相比异型程度显著下降(P<0.01)。但是,有1名患者自行将舒林酸减至每天100mg,一年后发生结肠癌。结论舒林酸长期维持治疗可使家族性腺瘤性息肉病患者结直肠腺瘤保持长期显著消退状态,结直肠残存腺瘤异型程度下降,绒毛管状腺瘤减少。但是腺瘤消退与维持剂量有关,剂量过小无效,而且舒林酸对腺瘤的消退作用是不完全的,患者仍需定期复查肠镜,早期发现结直肠癌。Objective To evaluate the long term effect of sulindac in attempting to maintain the regression of colorectal adenomas and changing of pathology of familial adenomatous polyposis （FAP） patients. Methods FAP patients who were diagnosed by family history and colonscopy were treated with sulindac 400mg per day. The patients received colonoscopy examination regularly to assess number of polyps. Biopsies of remnant polyps were obtained. The type and dysplasia grade of biopsies were evaluated and compared with baseline. Results Eighteen patients of FAP received sulindac. The average age was （37.4 ± 9. 8） years old. The average period of treatment was （65.3 ± 31. 6） months. Compared with baseline, the average number of polyps reduced significantly at last follow-up （P〈0. 01）. There were totally 200 adenoma biopsies obtained before the treatment. Among them, 86. 5% were tubular, while 13.0% were tubulovillous adenoma and 0. 5% was villous adenoma. The dysplasia of grade Ⅰ , Ⅱ and Ⅲ were 40. 0%, 43. 5% and 11.5%, respectively. After sulindac treatment, there were totaly 133 adenoma biopsies obtained. 97. 7% of adenoma biopsies were tubular adenoma, while 2. 3% were tubulovillous ade noma. There was significant difference compared with baseline （P〈0. 01）. The dysplasia of grade Ⅰ , Ⅱ and Ⅲ were 48. 9%, 48. 1% and 3.0% respectively, which had significant difference with baseline （P 〈0. 01）. However, 1 patient who took sulindac 100 mg/d by himself developed colonic cancer. Conclusion Long-term use of sulindac seems to be effective in maintaining the regression of colorectal adenoma of FAP patients and reducing dysplasia grade and tubulovillous adenoma of retained colorectal adenoma. These effects are associated with dosage. However, the effect of sulindac to regress the adenoma seems to be uncompleted. FAP patients who take sulindac need to receive colonoscopy regularly to find colorec tal cancer.

关 键 词：家族性腺瘤性息肉病 舒林酸 化学预防 

分 类 号：R735.35[医药卫生—肿瘤] R735.37[医药卫生—临床医学]