2058例结直肠息肉病理类型和解剖位置分析  

Analysis of pathological features and anatomical position of 2058 cases of colorectal polyp

作　　者：杨竞[1] 范南南[1] 蔡顺天[1] 杨云生[1] 

机构地区：[1]解放军总医院消化内科,北京100853

出　　处：《解放军医学杂志》2013年第5期391-394,共4页Medical Journal of Chinese People's Liberation Army

摘　　要：目的分析不同年龄患者结直肠息肉检出率、病理类型及在不同解剖部位的分布情况。方法回顾性分析2010年1月1日-12月31日解放军总医院消化内镜中心接受肠镜检查的患者,搜集一般临床资料并计算息肉检出率。将患者根据年龄分层,分析〈50、50～60,60～70,≥70岁患者的息肉检出情况;计算各种病理类型息肉的比例及在各解剖部位的分布;分析不同病理类型息肉伴发癌变的情况。结果 2010年共行结肠镜检查7117例,内镜下诊断息肉2614例,内镜下息肉检出率36.74%,患者男女比例2.1：1（1760：854）,年龄2～92岁,平均59.3岁。患者根据年龄分层分析结果显示,内镜下息肉检出率随年龄增加而升高,70岁以上人群检出率最高达55.24%。对息肉病理类型进行的分析显示,组织学诊断为息肉患者1372例,2058枚息肉。腺瘤性息肉在结直肠息肉中占84.16%（1732/2058）,其中管状腺瘤占75.35%（1305/1732）。对息肉解剖部位进行的分析显示,1287枚（62.54%）息肉位于左半结肠和直肠,771枚（37.46%）位于右半结肠;腺瘤中1039枚（59.99%）和非肿瘤性息肉中249枚（76.39%）均分布于左半结肠和直肠。在息肉的恶变情况病理变化方向,7.0%（96例）的患者在发现息肉时已伴发癌变,腺瘤占癌变息肉总数的96.9%,其中绒毛状腺瘤癌变率最高,达43.33%。结论结直肠息肉是结直肠镜检查最常见的阳性发现,男性发病率高于女性,其检出率随年龄的增加而增加,50岁以上人群是结直肠息肉的筛查重点。在结肠镜检时应对结肠进行完整检查,重点是直肠和乙状结肠。结直肠息肉的主要类型是腺瘤,以绒毛状腺瘤的癌变率最高。对内镜下诊断为息肉的病变均应进行组织学检查,明确性质,警惕癌变。Objective To analyze the detection rate of colorectal polyp by colonoscopy in different age groups, and investigate the histological classification of colorectal polyps and their distribution of different anatomic sites. Methods Endoscopic reports of patients, who underwent colonoscopy during 2010, were retrospectively reviewed, and the general data of patients and the detection rate of colorectal polyps were collected. Patients were grouped according to their age into 〈SO, S0-60, 60-70 and ≥ 70 groups. The proportion, the distribution at different anatomic sites, and concomitant malignant degeneration of different histological types of polyps were analyzed. Results A total of 7117 colonoscopic procedures were performed in 2010, and 2614 patients were diagnosed to suffer from colorectal polyp. The detection rate of polyps was 36.73%, and its incidence rose with advancing age, and reaching SS.24% in patients aged above 70 years. 2058 polyps in 1372 patients were histologically confirmed, and the mean age of them was 59.3 years, with the sex ratio of 2.2：1 in male vs female. 84.16% of the polyps were adenomas, of which 75.35% were tubular adenomas. 1288 （62.54%） polyps were located in descending colon and rectum, while 771 （37.46%） were located in ascending colon. S9.99% of adenomas and 76.39% of non-neoplastic polyps were located in descending colon and rectum. Cancerous degeneration was found in polyps of 96 patients （7.0%） when polyps were found, and adenomas accounted for 96.9% of cancerous polyps. Malignancy was found in 43.33% of villous adenomas. Conclusions Colorectal polyp is the commonest positive findings through colonoscopy, and dominant patients are males. Detection rate of polyps by colonoscopy is increased with advancing age. Persons aged above S0 years constituted the major group for examination, and rectum and sigmoid colon are the major sites of colorectal polyps. Adenoma is the main pathological type of colorectal polyp, of which tubular adenoma is the most common subtype, and m

关 键 词：肠息肉病 腺瘤性息肉 结肠镜检查 

分 类 号：R574.629[医药卫生—消化系统]