结直肠腺瘤分布特征及危险因素分析  

Distribution characteristics and risk factors of colorectal adenomas

作　　者：周海萍[1] 沈忠磊 赵坚培[1] 周振东 徐一栋[1] Zhou Haiping;Shen Zhonglei;Zhao Jianpei;Zhou Zhendong;Xu Yidong(Department of Colorectal Surgery, Ningbo No.2 Hospital, Ningbo 315010, China)

机构地区：[1]宁波市第二医院肛肠科,315010

出　　处：《中华胃肠外科杂志》2018年第6期678-684,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：浙江省医药卫生科技计划（2018KY699）

摘　　要：目的了解宁波地区结直肠腺瘤检出率和分布特征，并探讨腺瘤发生的危险因素，从而为结直肠腺瘤的筛查提供参考。 方法对2016年1—12月间在宁波市第二医院接受结肠镜检查的8660例受检者进行横断面调查，调查问卷包括年龄、性别、身高、体质量、吸烟史、饮酒史、糖尿病、高血压、高脂血症、肿瘤家族史、喜食红肉、喜食果蔬、腌制食品进食频率、每日运动量以及有无肠道预警症状。肠镜检查中所发现息肉原则上均予内镜下切除并送病理检查。根据组织学结果将息肉分为非腺瘤性息肉（包括增生性息肉和炎性息肉）和腺瘤性息肉（包括管状腺瘤、绒毛状腺瘤、管状绒毛状腺瘤和锯齿状腺瘤）。分析不同部位腺瘤的病理特征，并应用logistic回归模型确定结直肠腺瘤的危险因素。 结果7077例完成问卷的受检者纳入研究，其中男性3633例，女性3444例，年龄17~83（中位数53）岁。腺瘤检出率为15.6%（1103/7077），其中男性和女性腺瘤检出率分别为21.0%（762/3633）和9.9%（341/3444），差异有统计学意义（P= 0.000）。按年龄段，〈 30岁、30~39岁、40~49岁、50~59岁、60~69岁和≥70岁患者腺瘤检出率分别为6.2%（29/469）、8.0%（87/1086）、12.1%（148/1222）、16.8%（272/1623）、20.4%（326/1601）和22.4%（241/1076），腺瘤检出率均随年龄增长呈上升趋势（P= 0.000）。本组1103例腺瘤患者共检出腺瘤1521枚，其中管状腺瘤1455枚，管状绒毛状腺瘤33枚，绒毛状腺瘤9枚，锯齿状腺瘤24枚；腺瘤位于右半结肠671枚（44.1%），左半结肠593枚（39.0%），直肠257枚（16.9%）。锯齿状腺瘤和高危腺瘤（高级别上皮内瘤变、直径≥10 mm或含有绒毛成分的腺瘤）在右半结肠腺瘤中的比例显著高于左半结肠和直肠[2.5%（17/671）比0.8%（5/593）和0.8%（2/257），P= 0.029；9.2%（62/671）比5.2%（31/593）和6.6%（17/257ObjectiveTo determine the detection rate and distribution characteristics of colorectal adenomas in Ningbo area of China, and to identify the risk factors for colorectal adenoma, in order to provide reference for colorectal cancer screening. MethodsA cross-sectional study was performed among 8660 subjects undergoing colonoscopy in the Ningbo No.2 Hospital between January and December 2016, using a questionnaire, including demographic data （age, gender, height and weight） , history of diseases （diabetes, hypertension, hyperlipidemia, and family history of malignant neoplasm） , lifestyle （smoking, alcohol, dietary bias on red meat, dietary bias on fruit and vegetables, dietary frequency of pickled food and physical activities） , and intestinal early warning symptoms. All colonoscopically detected polyps were removed for histological examination. Polyps were histologically divided into non-adenomatous （hyperplastic polyps and inflammatory polyps） and adenomatous polyps （tubular, villous, tubulovillous and serrated adenomas） . Pathologic features were analyzed according to anatomical site. Multivariate logistic regression analysis was used to identify the risk factors for colorectal adenoma. ResultsA total of 7077 subjects who received colonoscopic examination and completed the questionnaire survey were enrolled in this study. There were 3633 males and 3444 females with a median age of 53 （ranged 17 to 83） years. Adenoma detection rate was 15.6% （1103/7077） in all cases, 21.0% （762/3633） for males, and 9.9% （341/3444） for females （P= 0.000） . Detection rate of 6.2% （29/469） was recorded in individuals aged less than 30 years, 8.0% （87/1086） in those from 30 to 39 years, 12.1% （148/1222） in those from 40 to 49 years, 16.8% （272/1623） in those from 50 to 59 years, 20.4% （326/1601） in those from 60 to 69 years, and 22.4% （241/1076） in those ≥ 70 years. The detection rate increased according to age （P= 0.000） . A total of 1521 adenomas were detec

关 键 词：结直肠腺瘤 腺瘤检出率 结肠镜 危险因素 筛查 

分 类 号：R735.34[医药卫生—肿瘤]