大肠腺瘤摘除后5年复发率及随访间期的探讨  

A Five-year Follow-up of the Extirpation of Colorectal Adenoma

作　　者：吴正祥[1] 张明黎[1] 郑邦海[1] 王巧民[1] 殷保书[1] 

机构地区：[1]安徽省合肥市安徽省立医院消化内科,230001

出　　处：《胃肠病学》2001年第1期38-39,59,共3页Chinese Journal of Gastroenterology

摘　　要：目的：初步探讨大肠腺瘤摘除后的复发率及随访间期。方法：１０７例经病理检查确诊为大肠腺癌者，在腺瘤摘除后第３年及第５年行全结肠镜随访；随机选择１０７例初次结肠镜检查正常者在第５年随访全结肠镜作为对照。结果：对照组６０例接受随访者中，５例发现有小腺瘤或息肉（８．３％）。腺瘤组第３年７２例接受随访者中，２３例（３１．９％）发现管状腺瘤或增生性息肉；第５年有７６例患者接受随访，共发现２５例３７枚息肉（复发率３２．９％；９６％可信区间：２２．１％～４３．７％），复发率明显高于对照组（Ｐ＜０．０１），其中２３例为管状腺癌，２例为增生性息肉，最大腺瘤直径为１２ ｍｍ。第５年时，原腺瘤数为１、２或２枚以上者的复发率分别为２０．０％、３８．９％和５５．６％（Ｐ＝０．０２４）；原腺瘤直径≥５ｍｍ及＞５ｍｍ者的复发率分别为２３．４％和４８．３％（Ｐ＝０．０２５）；复发率与患者的年龄及腺瘤位置关系不大。结论：多发性腺瘤患者及有较大腺瘤者较易复发；腺瘤摘除后５年内随访是安全的；对小的单发低度增生不良腺瘤患者及初次检查正常者，可延长随访间期。Background/Aims: To determine the frequency of recurrence of colonic polyp and follow-up interval in patients who had initial extirpation of adenomas. Methods: Colonoscopy was repeated at the 3rd and the sib year in 107 patients who had their colonic adenomas extirpated, 107 patients served as controls 5 years after a normal initial colonoscopy. Results: Among the adenoma group and control group, the follow-up rates were 76/107 and 60/107 at the sib year, respectively. 5/60 controls had newly grown small adenomas or polyps, while polyps were found in 23/72 patients at the 3rd year and in 25/76 patients (37 polyps) at the sib year follow-up (recurrence rate: 32.9%; 95% confidence interval: 22.1% -43.7%), 23 had tubular adenoma and 2 had hyperplastic polyp. The incidence of recurrent polyp was significantly higher in the adenoma group than that in the control group (P<0.01), the largest adenoma being 12 mm. Patients who initially had 1, 2 or more adenomas had recurrence rate of 20.0%, 38.9% and 55.6%, respectively (P= 0.024) and the size of adenoma on the initial examination ≤ 5 mm or > 5 mm showed recurrence rate of 23.4% and 48.3%, respectively (P=0.025). No relationship was found between the recurrence rate and the age of patients and distribution of polyps. Conclusions: Large and multiple adenomas have higher recurrence rate, but it may be save to repeat the colonoscopy at 5 years after the initial extirpation, while for mild dysplasia, small single adenoma or those with normal initial colonoscopy, the follow-up interval could be longer.

关 键 词：结肠直肠肿瘤 大肠腺瘤 随访研究 结肠镜检查 复发 

分 类 号：R735.34[医药卫生—肿瘤]