结直肠锯齿状腺瘤与传统腺瘤的内镜表现和病理学特征比较  

Endoscopic and pathological features of colorectal serrated adenoma： comparison with traditional adenoma

作　　者：李姝[1] 王邦茂[1] 徐东波[2] 王涛[1] 陈鑫[1] 方维丽[1] 刘文天[1] 

机构地区：[1]天津医科大学总医院消化科,天津300052 [2]天津医科大学总医院病理科,天津300052

出　　处：《中华消化内镜杂志》2014年第7期398-402,共5页Chinese Journal of Digestive Endoscopy

基　　金：天津市卫生局科技基金（07k222）

摘　　要：目的通过分析结直肠锯齿状腺瘤（SA）和传统腺瘤的内镜和病理学特征的差异，加强对SA的认识。方法比较2008年6月至2013年10月天津医科大学总医院消化内镜中心检出的80例SA和160例传统腺瘤的一般情况、内镜表现和病理学特征。结果SA患者平均年龄比传统腺瘤患者小[（57．5±13．8）岁和（62．3±12．2）岁，P=0．0038]，而男女性别构成，两组间差异无统计学意义（P〉0．05）。在内镜特征方面，SA主要发生于直乙结肠（60％），传统腺瘤好发部位为直乙结肠（45％）、升结肠（20％）和降结肠（19％），两组病变部位差异有统计学意义（P〈0．05）；在内镜形态分型（隆起型及表面型）和腺瘤大小方面比较，两组组间差异亦无统计学意义（P〉0．05）。在病理学方面，SA具有独特的锯齿状结构，传统腺瘤为管状、管状绒毛状和绒毛状结构。传统腺瘤的低级别瘤变率高于SA（P〈0．05），但sA仍有约1．9％的局部恶变率。结论sA与传统腺瘤在年龄、发生部位和病理学特征方面存在差异，是一种独特的腺瘤类型，有一定恶变潜能，应引起临床和内镜医师的高度重视。Objective To analyze the differences in endoscopic and pathological features between colorectat serrated adenoma （SA） and colorectal traditional adenoma. Methods The endoscopic and patho- logical features of 80 cases of SA and 160 cases of traditional adenoma diagnosed from June 2008 to October 2013 were retrospectively analyzed. Results The SA patients were younger than the traditional adenoma pa- tients（57.5 VS 62.3 ,P =0. 003 8）. The lesions of SA were mostly located in rectosigmoid colon （60%） , while the traditional adenoma could be found in rectosigmoid colon （45%）, ascending colon （20%） and descending colon （19%）. There were significant differences in the lesion＇s location between two kinds of adenoma （P 〈 0. 05 ）. There were no differences in gender, the size of lesion or endoscopic classification. In terms of the pathological features, SA had the serrated structure, whereas tubular, tubulovillous and villous structure were found in traditional adenoma. Cancer could be found in 1.9% of SA, which was lower than that of traditional adenoma （P 〈 0. 05）. Conclusion Serrated adenoma is different from traditional adenoma on the patient＇s age, lesion＇s location and pathological features. It is an unique kind of adenoma with poten- tial malignancy, which should be emphasized in clinical practice.

关 键 词：结直肠 锯齿状腺瘤 传统腺瘤 结肠镜检查 病理学 

分 类 号：R735.3[医药卫生—肿瘤]