结直肠大息肉的癌变风险分析  

Risk analysis of the eaneeration of colorectal large polyps

作　　者：金燕 姚礼庆 周平红 金士毛 王小云 唐学军 彭晓斌 华萍 任元梅 龚镭 Jin Yah;Yao Liqing;Zhou Pinghong;Jin Shimao;Wang Xiaoyun;Tang Xuejun;Peng Xiaobin;Hua Ping;Ren Yuanmei;Gong Lei(Endoscopy Center,The Affiliated Wuxi Second People＇s hospital of Nanjing Medical University,Jiangsu 214002,China;Endoscopy Center,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]南京医科大学附属无锡第二医院内镜中心,江苏214002 [2]复旦大学附属中山医院内镜中心,上海200032

出　　处：《中华胃肠外科杂志》2018年第10期1161-1166,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：无锡青年人才基金（QNRC075）;无锡市第二人民医院樊代明院士工作站（CYR1705）;无锡市重点学科胃肠病学（ZDXK002）;国家卫生与计划生育委员会卫生科技发展研究中心课题（W2015JZC12）;上海市消化内镜诊疗工程技术研究中心支持项目（16DZ2280900）

摘　　要：目的分析肠镜检查发现的结直肠大息肉（直径≥10 mm）发生癌变的风险因素。方法采用回顾性病例对照研究方法，回顾性分析2015年1月至2016年12月期间，南京医科大学附属无锡第二医院（207例）与复旦大学附属中山医院（211例）两家中心肠镜检查发现的直径≥10 mm、病理符合结直肠息肉的418例结直肠大息肉患者病历资料，包括息肉大小、部位、是否多发、术后病理和随访信息等，分析其与癌变的关系，采用χ^2检验进行单因素分析，采用logistic回归进行多因素分析（多发性息肉患者若术后病理提示全为低级别上皮内瘤变者，选择直径最大的一枚息肉进入模型；有高级别上皮内瘤变者，选择直径最大的一枚高级别上皮内瘤变息肉进入模型）。本研究将高级别上皮内瘤变及癌定义为癌变。结果418例患者中男278例（66.5%），女140例（33.5%），年龄15~87（58.7±10.2）岁。其中398例患者经内镜下切除息肉456枚，有142例（150枚）发生癌变，包括高级别上皮内瘤变134枚和黏膜内癌16枚；20例患者在内镜治疗时黏膜下注射抬举征阴性，转外科手术治疗，切除息肉20枚，组织学检查均发现浸润性癌变。单因素分析显示，年龄≥50岁[40.5%（150/370）比25.0%（12/48），χ^2=4.323，P=0.041]、多发息肉[77.5%（31/40）比34.7%（131/378），χ^2=12.900，P=0.001]、息肉位于直肠[59.0%（36/61）比32.3%（134/415），χ^2=22.736，P=0.000]、直径≥31 mm[74.1%（20/27）比33.4%（150/449），χ^2=36.493，P=0.000]以及病理分型为管状绒毛状腺瘤[67.4%（120/178）比16.8%（50/298），χ^2=71.810，P=0.000]患者癌变率更高。多因素分析显示，年龄≥50岁（OR=2.473，95%CI：1.209~5.058，P=0.013）、多发息肉（OR=2.472，95%CI：1.300~4.702，P=0.006）、息肉位置位于直肠（OR=1.253，95%CI：1.091~1.439，P=0.001）及息肉直径≥31 mm（OR=1.500，95%CI：1.196~1.88ObjectiveTo analyze the risk factors of carcinogenesis of large colorectal polyps （diameter ≥ 10 mm） found by colonoscopy.MethodsClinicopathological and follow-up data of 418 consecutive patients who were diagnosed as colorectal polyps with diameter≥10 mm by colonoscopy at two endoscopy centers of the Affiliated Wuxi Second People′s Hospital, Nanjing Medical University （n=207） and Zhongshan Hospital, Fudan University （n=211） from January 2015 to December 2016 were retrospectively collected. High-grade intraepithelial neoplasia and cancer were defined as malignancy in this study. Chi square test was used for univariate analysis, and logistic regression was used for multivariate analysis （in patients with multiple polyps, if the pathological findings were all low grade intraepithelial neoplasia, one polyp with the largest diameter was selected to enter the model; in patients with high grade intraepithelial neoplasia, one polyp of high grade intraepithelial neoplasia with the largest diameter was selected to enter the model） . Associated risk factors of malignancy were analyzed.ResultsAmong the 418 patients, 278 （66.5%） were male and 140 （33.5%） were female, with mean age of （58.7±10.2） （range 15-87） years old. Of 398 patients undergoing endoscopic treatment with resected 456 polyps, 142 cases with 150 polyps were malignant, including 134 polyps of high-grade intraepithelial neoplasia and 16 polyps of intra-mucosal cancer. The other 20 patients showed negative elevation signs after endoscopic submucosal injection and were transferred to surgery, of whom 20 polyps were resected. Histological examination of these 20 polyps indicated invasive cancer. Univariate analysis showed that age ≥ 50 years[40.5% （150/370） vs. 25.0% （12/48） , χ^2=4.323, P=0.041], multiple polyps[77.5% （31/40） vs. 34.7% （131/378） , χ^2=12.900, P=0.001], polyp locating at rectum[59.0% （36/61） vs. 32.3% （134/415） , χ^2=22.736, P=0.000], polyp diameter ≥31 mm[74.1% （20/27） vs.

关 键 词：结直肠大息肉 癌变风险 内镜下治疗 

分 类 号：R735.34[医药卫生—肿瘤]