结直肠腺瘤切除术后息肉复发及内镜监测的临床分析  

The clinical analysis of the recurrence of colorectal adenoma after polypectomy and the endoscopic surveillance interval

作　　者：高辉[1] 张川[1] 阎雪燕[1] 袁志芳[1] 张继舜[1] 段卓洋[1] 

机构地区：[1]首都医科大学附属北京朝阳医院京西院区消化内科,北京100043

出　　处：《胃肠病学和肝病学杂志》2014年第3期308-310,共3页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的研究结直肠腺瘤（colorectal adenoma，CRA）切除术后息肉复发的情况，以确定合理的内镜监测间隔时间。方法收录2005年5月-2012年5月于北京朝阳医院消化内科完成结肠镜下息肉切除术、病理组织学确诊为CRA、术后再次人院行肠镜复查的患者共143例，男89例，女54例。统计分析复发息肉的累计复发率，确定影响复发息肉的重要危险因素和中位复发时间。结果息肉总体复发率为72％，患者性别、年龄、息肉大小、息肉数目、息肉发生部位、病理类型等因素中，仅CRA的大小和病理类型对复发有重要影响。初检CRA直径〉1cm的患者较CRA直径≤1cm的患者复发风险高（P=0．02）。CRA病理中含有绒毛成分的患者较仅为管状腺瘤的患者复发风险高（P=0．08）。结论建议含绒毛成分或直径〉1em的CRA患者术后6～12个月复查肠镜，而直径≤1cm的管状腺瘤患者可在术后2年左右复查肠镜。Objective To research the recurrence of colorectal adenoma （CRA） after polypectomy, and to deter- mine a reasonable endoscopic surveillance interval. Methods 143 CRA patients who underwent colonoscopic polypecto- my from May. 2005 to May. 2012 in our hospital, and then had a review colonoscopy later were collected. The cumula- tive recurrence rate of the CRA, the important risk factors affecting the CRA recurrence and the median time to recur- rence were analyzed. Results Overall recurrence rate of CRA was 72%. The size of the CRA and pathological type were the independent risk factors of recurrence. The patients with CRA diameter 〉 1 cm had a higher risk of recurrence than CRA diameter ≤1 cm （P = 0.02） , the patients with tubulovillous or villous adenomas had a high risk than the pa- tients with tubular adenoma （P = 0.08）. Conclusion We suggest a 6 - 12 months surveillance interval for patients with CRA diameter 〉 1 cm or tubulovillous or villous; a approximately 24 months surveillance interval for patients with tubular CRA and diameter≤1 cm.

关 键 词：腺瘤性息肉 结肠 电凝术 复发 结肠镜 

分 类 号：R574.6[医药卫生—消化系统]