结肠锯齿状病变临床病理分析  

Clinical pathology analysis of colon serrated lesions

作　　者：王续[1] 刘月平[1] 杨会钗[1] 王贵英[2] Wang Xu;Liu Yueping;Yang Huichai;Wang Guiying(Department of Pathology,Fourth Hospital of Hebei Medical University, Hebei 050000, China;2Department of General Surgery, Fourth Hospital of Hebei Medical University, Hebei 050000, China)

机构地区：[1]河北医科大学第四医院病理科,050000 [2]河北医科大学第四医院外二科

出　　处：《中华结直肠疾病电子杂志》2016年第5期413-418,共6页Chinese Journal of Colorectal Diseases(Electronic Edition)

摘　　要：目的 锯齿状病变代表一种异源性病变，其中一些具有恶性潜能。进一步明确锯齿状病变的临床病理特征，以期为临床治疗提供广阔思路。方法 对河北医科大学第四医院切除的788例结肠息肉病变进行形态学观察、免疫组化检测。按不同的检测方法确定每种锯齿状病变的临床病理特征，病变的比例通过χ2检验，P值＜0.05为差异具有统计学意义。结果 增生性息肉（hyperplasticpolyp，HP）占息肉总数比例较高（508，64.6%），好发于远端结肠（381，75.1%），多数伴有急性、慢性炎反应（330，64.9%；178，35.1%）；而在广基锯齿状腺瘤/息肉（sessileserratedadenoma，SSA）（伴或不伴不典型增生）、传统性锯齿状腺瘤（traditionalserratedadenoma，TSA）具有较多以下特征如伴发急性炎反应，平滑肌束长入固有层。以及临床特征中传统锯齿状腺瘤、广基锯齿状腺瘤/息肉伴异型增生中BRAF检测阳性44（62.8%）、19（35.2%）；而且有肠病恶变的患者中（TSA）比例较高42例及随访健康的患者中（HP）比例较高490例，两组比较差异具有统计学意义（χ2=21.438，P＜0.05）结论 锯齿状病变仍是一种在基因水平认识不足的综合征，而且与结肠腺癌的患病风险的相关性无从论证。因此，临床病理工作者对疾病的正确认识在需要每年检查结肠镜的患者中担任着非常重要的责任。Objective Serrated lesions represent a different kind of lesions, some of which have malignant potential. Understanding the clinical pathological characteristics of serrated lesions is essential for treatment. Methods Based on the morphological observation of pathological changes of 788 cases of colon polyps with immunohistochemical testing, better diagnosis according to the World Health Organization Criteria.According to different detection methods learned that each of the serrated lesions in clinical pathological features,by chi-square test, the difference is statistically significant (P < 0.05). Results The ratio of polyp numbers is high (508, 64.6%) , located at the distal colon (381, 75.1%), most associated with acute and chronic inflammatory response (330, 64.9%; 178, 35.1%). But in wide base serrated adenomatous polyps (SSA/P) / (with or without atypical hyperplasia), traditional serrated adenoma (TSA) with more features such as associated with acute and chronic inflammatory response, smooth muscle bundle of lamina propria ingrowth . And clinical characteristics of traditional serrated adenoma, wide base serrated adenoma/polyp with hyperplasia of BRAF testing positive for 44 19 (35.2%). And there is higher percentage (TSA) in patients with bowel disease malignant progression of 42 patients and follow-up health (HP) in the higher percentage of 490 , differences between the two groups have statisticd significance (χ2=21.438, P < 0.05). Conclusions The serrated lesions is still insufficientunderst anded, and the correlation between serrated lesions and colon cancer is not clear. Therefore, precise understanding the serrated lesions is very important for patients with enteroscopy.

关 键 词：结肠 腺瘤 锯齿状病变 病理 

分 类 号：R735.35[医药卫生—肿瘤]