结直肠息肉切除术后的再发特点及肠镜监测研究  

Investigation on colorectal polyp recurrence and colonoscopic surveillance after polypectomy

作　　者：钟清连[1] 郑昌京[1] 黄健[1] 陈红敏[1] 林嘉裕 黄群[1] 

机构地区：[1]广东医学院附属深圳福田人民医院消化内科,深圳518033

出　　处：《中国医师杂志》2016年第7期1005-1007,1012,共4页Journal of Chinese Physician

基　　金：深圳市福田区科技创新局基金（FTWS2014015）

摘　　要：目的分析结直肠息肉切除术后再发的临床特点及影响因素，为息肉患者风险分层及指导肠镜监测时间提供参考依据。方法 收集2012年1月至2015年8月在本院行肠镜检查确诊大肠息肉并行息肉切除术的患者为观察对象，并在2年内复查肠镜，统计息肉再发率，比较低危和高危人群、肿瘤性和非肿瘤性息肉的再发情况，分析其再发的临床特点及影响因素。结果 息肉再发率为71.6%（139/194）。息肉再发与患者年龄、息肉数量及部位有关（P〈0.05），与息肉大小、病理类型无关（P〉0.05）。Logistics分析结果示息肉多发及年龄是影响息肉再发的独立因素。高危人群经肠镜下息肉切除后其高危人群比例明显下降，65.9%转为基线人群或低危，但低危人群有15.5%转为高危。肿瘤性息肉切除术后仍有48.5%再发为腺瘤，19.4%非肿瘤性的再发为肿瘤性息肉。结论 息肉多发及年龄是影响息肉再发的独立因素，但用息肉大小、病理类型对息肉患者进行危险分层指导肠镜监测时间存在局限性。在高质量肠镜检查及治疗的前提下，2年内复查肠镜的间隔时间是经济可行的。Objective To investigate the clinical characteristics and analyze the influencing factors of colorecta[ polyp recurrence after polypectomy. Methods The clinical data of colorectal polyps patients, who underwent colonoscopic polypectomy in our hospital and received a follow-up colonoscopy within 2 years [ mean interval （ 18.8 ± 8. 42 ）months ] were collected between January 2012 and August 2015 （ n = 194 ）. The polyps size, number, location, and pathology were detected. The polyps recurrence rate and influencing factors were analyzed. Results The polyps recurrence rate was 71.6% （139/194） in 2 years. The patients, who aged I〉60 years, with adenoma number≥3, located in the left hemicolon and rectum, were easier to recurrence （ P 〈 0. 05）. Logistic regression analysis revealed that age and number of adenomas were inde-pendent factors of polyps recurrence whereas the sex, size, location, and pathology were not （ P 〈 0. 05 ） during the surveillance interval. However, 19. 4% nonneoplastic-polyp group and 15.5% low-risk group turn into bad side. Conclusions The outcomes indicate that age and number of adenomas≥3 were independent factors of polyps recurrence ,whereas the size and pathological type were limited in risk stratification for patients after polypectomy. Two year may be the appropriate interval for endoscopic rescreening.

关 键 词：结肠息肉/外科学 复发 内窥镜检查 消化系统 

分 类 号：R656[医药卫生—外科学]