上消化道锯齿状病变的临床病理特征分析  

Clinical and pathological features of upper gastrointestinal serrated lesions

作　　者：邓宝茹[1] 董文逍 曹海龙[1] 王邦茂[1] 

机构地区：[1]天津医科大学总医院消化内科,天津300052

出　　处：《中华消化内镜杂志》2017年第6期410-413,共4页Chinese Journal of Digestive Endoscopy

基　　金：国家自然科学基金（81570478,81470796,81300272）

摘　　要：目的探讨上消化道锯齿状病变患者的临床及病理特征。方法2011年1月至2015年12月，在天津医科大学总医院消化内镜中心行上消化道内镜检查，并经活检病理诊断为上消化道锯齿状病变的21例患者资料纳入回顾性分析，总结临床及病理特征。其中18例同期（6个月内）进一步行结肠镜检查者纳入病例组，并按1：4的比例选取同期行上消化道内镜和结肠镜检查未发现上消化道锯齿状病变的患者组成对照组（n=72），对比分析2组的结直肠腺瘤检出情况。结果21例上消化道锯齿状病变患者中，男11例、女10例，平均年龄（55．3±17．2）岁，病变位于食管下部1例、胃17例（其中贲门3例、胃体9例、幽门5例）、十二指肠3例，黏膜病理形态表现为锯齿状增生6例、增生性息肉8例、锯齿状腺瘤伴轻度不典型增生6例、十二指肠黏膜内癌1例。病例组检出结直肠腺瘤7例（38．9％），其中结肠非进展期腺瘤3例（16．7％）、进展期腺瘤4例（22．2％）；对照组检出结直肠腺瘤8例（11．1％），其中非进展期腺瘤5例（6．9％）、进展期腺瘤3例（4．2％）。病例组结直肠腺瘤检出率明显高于对照组（38．9％比11．1％，P=0．010，OR=5．091，95％CI：1．534-16．890）。结论上消化道锯齿状病变可于不同黏膜病变中检出，具有不同的病理学特征。上消化道锯齿状病变患者的结直肠腺瘤检出率较高，建议进行结肠镜检查以除外并发的结直肠腺瘤。Objective To analyze the clinical and pathological features of upper gastrointestinal serrated lesions. Methods A total of 21 patients with upper gastrointestinal serrated lesions in Tianjin Medical University General Hospital between January 2011 and December 2015 were retrospective analyzed. Data of the patients including demographics, clinical and pathological features were collected. Among the 21 patients, 18 patients, who underwent colonoscopy simultaneously or within six months, were selected as the study group, each patient was compared to 4 randomly selected controls without serrated lesions, who also underwent colonoscopy within the same time period. Differences of colorectal neoplasia detection were analyzed between the cases and controls. Results The mean age of 21 patients was 55.3±17.2 years, and 11 cases were male. Involving the locations of serrated lesions, 17 cases were found in the stomach （ including 3 in the cardia, 9 in the corpus, and 5 in the antrum）, and followed by 3 in the duodenum and 1 in lower esophagus. The mucosa pathological morphology showed that 6 cases were serrated hyperplasia, 8 cases were hyperplastic polyps, 6 cases were serrated adenomas with low grade dysplasia and 1 case was in the duodenum intramucosal carcinoma. Seven （ 38.9% ） colorectal adenomas were found in the study group, including 3 （16. 7%） non-advanced colorectal adenomas and 4 （22. 2%） advanced colorectal adenomas. Eight （11.1%） colorectal adenomas were found in the control group, including 5 （ 6. 9% ） non-advanced colorectal adenomas and 3 （4. 2% ） advanced colorectal adenomas. The rate of colorectal adenoma detection in the study group was significantly higher than that in the control group （38.9% VS 11.1%, P= 0. 010, OR = 5. 091, 95% CI： 1. 534-16. 890）. Conclusion Upper gastrointestinal serrated lesions can be found in various mucosal lesions with different pathological morphologies. Moreover colonoscopy is likely to be recommended to detect concurrent eolorectal adenoma

关 键 词：内镜检查 上消化道 锯齿状病变 结直肠腺瘤 

分 类 号：R735.34[医药卫生—肿瘤]