直肠息肉中哨兵息肉的临床特点及与近端结肠癌的关系  

Correlation between sentinel polyps and proximal colon carcinoma and analysis of its clinical fea-tures

作　　者：魏光兰 赵达[2] 

机构地区：[1]积石山县中西医结合医院普内科,甘肃省积石山731701 [2]兰州大学第一附属医院肿瘤内科,兰州730000

出　　处：《中国医师杂志》2016年第9期1353-1356,共4页Journal of Chinese Physician

摘　　要：目的分析直肠息肉中哨兵息肉（直肠息肉并发近端结肠癌）患者临床特点以及哨兵息肉与近端结肠癌间相关性。 方法331例直肠息肉患者按并发近端的结肠癌情况分为观察组（哨兵息肉组）37例及对照组（单纯直肠息肉组）294例，对比分析两组患者的内镜下特征、病理学特征、血清肿瘤标志物、治疗情况以及转归等。 结果观察组肿瘤标志物的阳性率[67.6%（25/37）]明显高于对照组[6.8%（20/294）]，差异有统计学意义（χ2＝32.174，P〈0.01）。与对照组比较，观察组息肉最大径〉1 cm[62.2%（23/37）]、多发性（息肉〉5枚）息肉[43.2%（16/37）]、腺瘤性息肉[83.8%（31/37）]的比例均明显高于对照组[46.6%（137/294）、11.9%（35/294）、35.4%（104/294）]，差异均有统计学意义（χ2＝10.863、15.686、22.653，均P〈0.01）。哨兵息肉近端结肠癌多为乳头状腺癌及管状腺癌，占75.7%（28/37）；Duke A期29.7%（11/37），B期29.7%（11/37），C期24.3%（9/37），D期16.2%（6/37）。对照组96.6%（282/294）患者接受内镜治疗且痊愈出院；观察组40.5%（15/37）接受根治术，24.3%（9/37）接受内镜下治疗。 结论如直肠存在最大径〉1 cm、多发性及腺瘤性的息肉时，需警惕息肉本身以及近端结肠发生癌变的可能，应在短期内对患者随访并进行全结肠的检查。ObjectiveTo explore the clinical features of sentinel polyps （rectal polyps with proximal colon carcinoma） and its correlation with proximal colon carcinoma. MethodsFrom January 2011 to June 2015, the clinical features of 331 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=294） and sentinel polyps group （n=37）. The characteristics under endoscopy, clinical pathological features, treatment and prognosis of two groups were observed.ResultsThe positive rate of tumor marker of sentinel polyps group was higher （67.6 %, 25/37） than that of pure polyps group （6.8 %, 20/294; χ2=32.174, P〈0.01）. When compared to pure polyps group, most polyps of sentinel polyps group were in maximum diameter over 1 cm [62.2% （23/37） vs 46.9 % （138/294）], multi-polyps [n〉5, 43.2% （16/37） vs 11.6 % （34/294）] and adenomatous polyp [83.8 % （31/37） vs 35.7 % （105/294）] （χ2=10.863, 15.686, and 22.653, P〈0.01）. Majority of the proximal colon carcinoma with rectal polyps was papillary adenoearcinoma and tubular adenocarcinoma which was account for 75.7 % （28/37）; Duke A, 29.7% （11/37）, Duke B, 29.7%（11/37）, Duke C, 24.3% （9/37） and Duke D, 16.2% （6/37）. 96.6 % （282/294） of patients with pure polyps underwent endoscopic treatment and all of them were cured and discharged. 40.5% （15/37） of patients of sentinel polyps group accepted the radical operation and 24.3% （9/37） received endoscopic submucosal dissection.ConclusionsIf multiple, maximum diameter over 1 cm and adenomatous rectal polyps were detected under colon endoscope, the possibility of carcinogenesis of the polyps or the proximal colon should be aware. The patient should be followed up in short-term and complete the whole colon examination.

关 键 词：肠息肉/并发症 结肠肿瘤/并发症 

分 类 号：R735.35[医药卫生—肿瘤]