哨兵息肉与近端结肠癌的相关性及其临床特点分析  

Correlation between sentinel polyps and proximal colon carcinoma and analysis of its clinical features

作　　者：崔凝[1] 罗和生[1] 刘军[1] 陈炜[1] 全晓静[1] 

机构地区：[1]武汉大学人民医院消化内科,430060

出　　处：《中华消化杂志》2015年第4期231-234,共4页Chinese Journal of Digestion

摘　　要：目的 探讨哨兵息肉（即直肠息肉并发近端结肠癌）患者的临床特点及哨兵息肉与近端结肠癌的相关性.方法 回顾性分析2003年1月至2013年12月963例因直肠息肉住院患者的病例资料.按是否并发近端结肠癌将患者分为哨兵息肉组（108例）和单纯直肠息肉组（855例）,观察两组内镜下特点、临床病理学特征、治疗与转归情况等,组间差异采用卡方检验进行比较.结果 963例患者总住院时间为4∽33 d,平均年龄为（49.7±9.4）岁,以男性（610例,63.3％）居多.785例患者（81.5％）有排便次数/习惯改变、便血、腹痛、腹胀等非特异性下腹部症状.78例（8.1％）患者有三代血缘内的亲属确诊患肿瘤,亦有部分患者亲属确诊为家族性腺瘤性息肉病（2.2％,21/963）.哨兵息肉组的肿瘤标志物阳性率（69.4％,75/108）较单纯息肉组高（6.8％,58/855;χ2=316.285,P＜0.01）.哨兵息肉患者内镜下近端结肠癌多表现为新生物样环绕管腔生长,但在发现远端直肠息肉直到进镜至近端结肠癌间的肠管并无特殊表现.哨兵息肉组与单纯直肠息肉组相比,哨兵息肉组最大径＞l cm的息肉、多发性息肉（息肉数＞5枚）、腺瘤性息肉多见[61.1％（66/108）比46.9％（401/855）,38.9％（42/108）比11.8％（101/855）,83.3％（90/108）比35.6％（304/855）,χ2=7.752、55.595、90.544,P均＜0.01].哨兵息肉伴发的近端结肠癌以乳头状腺癌和管状腺癌多见,共占75.9％（82/108）,亦可见黏液癌及印戒细胞癌等.59.3％（64/108）的伴发结肠恶性肿瘤未穿透浆膜层（即Duke A期和B期）,已有远处脏器转移者（即Duke D期）较少（19/108,17.6％）.95.6％（817/855）的单纯直肠息肉患者接受了内镜治疗,均痊愈出院;哨兵息肉组中41.7％（45/108）接受外科根治手术,19.4％（21/108）接受内镜黏膜下剥离术.结论 结肠镜检查发现直肠多发的、最大径＞1 cm和腺瘤性息肉时,应警�Objective To explore the clinical features of sentinel polyps （rectal polyps with proximal colon carcinoma） and its correlation with proximal colon carcinoma.Methods From January 2003 to December 2013,the clinical features of 963 hospitalized patients with rectal polyps were retrospectively analyzed.According to whether the patient with colon carcinoma,the clinical data of rectal polyps patients were divided into pure polyps group （n=855） and sentinel polyps group （n 108）.The characteristics under endoscopy,clinical pathological features,treatment and prognosis of the two groups were observed.Chi square test was performed for differences comparison between groups.Results The length of stay in hospital of 963 patients was from four to 33 days,the average age was （49.7 ± 9.4） years,and the majority of the patients were male （n=610,63.3%）.A total of 785 patients （81.5%） had non-specific abdominal symptoms,such as frequency or habit change of defecation,hematochezia,abdominal pain,abdominal distension.The relatives within three generation of 78 patients （8.1 %） were diagnosed with tumor and some relatives of the patients diagnosed with familial adenomatous polyposis （2.2%,21/963）.The positive rate of tumor marker of sentinel polyps group was higher （69.4%,75/ 108） than that of pure polyps group （6.8%,58/855; χ2 =316.285,P〈0.01）.The proximal colon carcinoma of patients with sentinel polyps appeared as neoplasma with circumferential growth,there was no specific appearance between distal rectal polyps and proximal colon carcinoma.When compared with pure polyps group,most polyps of sentinel polyps group were in maximum diameter over 1 cm （61.1% （66/108） vs 46.9% （401/855））,multi polyps （n〉5,38.9% （42/108） vs 11.8% （101/855）） and adenomatous polyp （83.3% （90/108） vs 35.6%（304/855）,χ2=7.752,55.595 and 90.544,all P〈 0.01）.Majority of the proximal colon carcinoma with rectal polyps was papillary adenocarcinoma and tubular adenocarcinoma whic

关 键 词：哨兵息肉 直肠息肉 结肠肿瘤 结肠镜 

分 类 号：R735.3[医药卫生—肿瘤]