十二指肠乳头息肉良、恶性病变比较及活检准确性  

Characteristics of benign and malignant lesions of ampullary polyps and the accuracy of forceps biopsy

作　　者：王迎春[1] 黄永辉[1] 常虹[1] 姚炜[1] 闫秀娥[1] 李柯[1] 张耀鹏[1] 郑炜[1] WANG Ying-chun;HUANG Yong-hui;CHANG Hong;YAO Wei;YAN Xiu-e;LI Ke;ZHANG Yao-peng;ZHENG Wei(Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China)

机构地区：[1]北京大学第三医院消化科,北京100191

出　　处：《北京大学学报（医学版）》2021年第1期204-209,共6页Journal of Peking University:Health Sciences

基　　金：国家自然科学基金(81500502、81470905);北京市科学技术委员会首都临床特色应用研究项目(z171100001017091)。

摘　　要：目的:比较十二指肠乳头息肉良、恶性病变的内镜下及临床特点,探究内镜下预判十二指肠乳头腺瘤癌变的可行性,并评估内镜下乳头活检组织病理学诊断的准确性。方法:选择2009年1月至2019年5月在北京大学第三医院内镜中心接受内镜下十二指肠乳头切除术(endoscopic papillectomy,EP)患者的临床资料及内镜图片,分为良性病变及癌两组,进行对比分析。结果:研究共纳入42例患者,年龄35~83岁,50岁以上患者占83.3%(35/42)。42例患者中,炎性息肉2例(4.8%),神经内分泌瘤1例(2.4%),增生性息肉1例(2.4%),Ⅰ级腺瘤5例(11.9%),Ⅱ级腺瘤10例(23.8%),Ⅲ级腺瘤4例(9.5%),癌19例(45.2%),腺瘤和癌共占90.5%。良性病变(炎性息肉及腺瘤)组平均年龄(56.7±9.2)岁,癌组(66.0±9.8)岁,两组间差异有统计学意义(P=0.004)。癌[(2.3±0.8)cm]的直径显著大于良性病变[(1.6±0.6)cm,P=0.002]。良性病变均为山田(Yamada)Ⅰ型(57.1%)或Ⅱ型(42.9%)病变,而癌组山田Ⅰ型(36.8%)、Ⅱ型(31.6%)比例较低,31.5%为山田Ⅲ型病变。两组间山田分型差异有统计学意义,癌组带蒂倾向明显(P=0.046)。良性病变多与周围分界清楚(18/21,85.7%),而癌组分界多不明显,仅2例(10.5%)具有清晰的界限,两组间差异具有统计学意义(P<0.001)。息肉表面颜色(P=0.353)、表面形态(P=0.324)两组间差异无统计学意义。将差异有统计学意义的年龄、病变大小、山田分型、与周围界限是否清晰纳入Logistic回归分析,结果显示年龄(OR=1.186,95%CI:1.025~1.373,P=0.022)、与周围是否有清晰界限(OR=66.218,95%CI:3.421~1281.840,P=0.006)为乳头癌变风险的独立预判因素。19例癌患者中,术前仅2例(10.5%)活检诊断提示癌。17例癌(17/19,89.5%)、4例Ⅱ级腺瘤(4/10,40%)术前病理均低于实际病理分级,占病例总数的55.3%(21/38)。结论:十二指肠乳头息肉以腺瘤及癌为主,高龄、与周围黏膜界限不清为十二指肠乳头肿瘤癌变的独立预判Objective:To distinguish the endoscopic and clinical features of ampullary polyps,to investigate the endoscopic cancer risk factors of ampullary polyps based on the compared differences of benign lesions and adenocarcinoma,and to assess the accuracy of forceps biopsy.Methods:Authors retrospectively analyzed the data extracted from patients treated with endoscopic papillectomy(EP)from January 2009 to May 2019 in the Department of Gastroenterology,Peking University Third Hospital.Endoscopic pictures and pathology reports were reevaluated and analyzed.Differences between benign and cancer groups were conducted.Results:In the study,42 cases were involved,35 to 83 years old,containing 83.3%older than 50 years old patients.The histological types were as follows,2 for inflammatory polyps(4.8%),1 for neuroendocrine tumor(2.4%),1 for hyperplastic polyp(2.4%),5 for gradeⅠadenoma(11.9%),10 for gradeⅡadenoma(23.8%),4 for gradeⅢadenoma(9.5%)and 19 for adenocarcinoma(45.2%),and 90.5%were adenoma or adenocarcinoma.The average age of benign group(inflammatory polyps and adenomas)was(56.7±9.2),which was significantly younger than that of adenocarcinoma group[(66.0±9.8),P=0.004].Tumor diameter in adenocarcinoma group[(2.3±0.8)cm]was significantly larger than that in benign group[(1.6±0.6)cm,P=0.002].Benign lesions only showed Yamada typeⅠ(57.1%)and typeⅡ(42.9%).The percentage of Yamada typeⅠ(36.8%)and typeⅡ(31.6%)in adenocarcinoma group was lower than that in benign group.Moreover,Yamada typeⅢ(31.5%)was only found in the adenocarcinoma group.Significant differences were observed between the two groups in Yamada types(P=0.046).Most of the benign lesions had clear boundary(18/21,85.7%).The percentage of clear boundary in adenocarcinoma group(2/19,10.5%)was significantly lower than that in the benign group(P<0.001).No significant differences were investigated in color(P=0.353)and surface(P=0.324)between benign and adenocarcinoma lesions.Pooling age,lesion diameter,Yamada type and clear boundary into Logistic regre

关 键 词：腺瘤 腺癌 危险因素 病理特征 内镜下十二指肠乳头切除术 十二指肠乳头腺癌 癌变风险 活检病理准确性 

分 类 号：R574.51[医药卫生—消化系统]