结直肠镜下结直肠腺瘤切除术后复发的影响因素  

Influencing factors of recurrence after colonoscopic resection of colorectal adenoma

作　　者：李媛[1] 赵丽萍[1] 马欢[1] 张巍巍[1] 刘海平 唐东[1] 战淑慧[1] 高玉强[1] Li Yuan;Zhao Liping;Ma Huan;Zhang Weiwei;Liu Haiping;Tang Dong;Zhan Shuhui;Gao Yuqiang(Department of Gastroenterology,Qingdao Municipal Hospital(East District),Qingdao 266000,China)

机构地区：[1]青岛市市立医院(东院区)消化内科,266000

出　　处：《中华消化杂志》2020年第12期850-855,共6页Chinese Journal of Digestion

摘　　要：目的研究结直肠镜下结直肠腺瘤切除术后复发的影响因素。方法选择青岛市市立医院2014年1月至2016年8月行结肠镜下结直肠腺瘤切除术且在切除术后3年内有结肠镜随访结果的患者501例。分析性别、年龄、BMI、是否吸烟、是否合并非酒精性脂肪性肝病(NAFLD)、是否合并糖尿病,腺瘤最大径、数量、病理类型,以及手术方式对患者术后腺瘤复发率的影响,将差异有统计学意义的结果纳入多因素logistic回归模型,分析腺瘤复发的独立危险因素。统计学方法采用卡方检验和多因素logistic回归分析。结果 501例结肠镜下结直肠腺瘤切除术患者术后3年的腺瘤复发率为25.5%(128/501)。腺瘤复发率在不同性别和年龄的患者间的差异均无统计学意义(P均>0.05)。BMI为<25、25~29和>29 kg/m^(2)的患者的腺瘤复发率分别为19.2%(32/167)、27.5%(44/160)和29.9%(52/174),其中BMI>29 kg/m^(2)者的腺瘤复发率高于BMI<25 kg/m^(2)者,差异有统计学意义(χ^(2)=6.978,P<0.05),腺瘤复发率在BMI<25 kg/m^(2)与25~29 kg/m^(2)、BMI为25~29 kg/m^(2)与>29 kg/m^(2)的患者间的差异均无统计学意义(P均>0.05)。吸烟、合并NAFLD、合并糖尿病的患者的腺瘤复发率分别高于不吸烟、不合并NAFLD、不合并糖尿病的患者[32.9%(51/155)比22.3%(77/346)、27.6%(61/221)比23.9%(67/280)、31.3%(25/80)比24.5%(103/421)],差异均有统计学意义(χ^(2)=8.132、7.232、6.874,P均<0.05)。腺瘤最大径为≤5、>5~<10、10~<20和≥20 mm的患者腺瘤复发率分别为11.6%(23/198)、18.5%(23/124)、41.7%(43/103)、51.3%(39/76),其中最大径为10~<20 mm和≥20 mm的患者腺瘤复发率均高于最大径为≤5 mm和>5~<10 mm的患者,差异均有统计学意义(χ^(2)=35.990、14.690、49.440、23.650,P均<0.05),腺瘤复发率在最大径≤5 mm与>5~<10 mm、最大径为10~<20 mm与≥20 mm的患者间的差异均无统计学意义(P均>0.05)。有1、2和≥3个腺瘤的患者的腺瘤复发率分别为19.6%(20Objective To study the influencing factors of recurrence after colonoscopic resection of colorectal adenoma.Methods From January 2014 to August 2016,in Qingdao Municipal Hospital,501 patients who underwent colonoscopic resection of colorectal adenoma and were followed up by colonoscopy within three years after resection were selected.The effects of gender,age,body mass index(BMI),smoking,non-alcoholic fatty liver disease(NAFLD),diabetes,and the maximum diameter,number,pathologic type of adenoma,and operation method on the recurrence rates of adenoma after resection.Multivariate logistic regression model was used to analyze the independent risk factors of adenoma recurrence in the results with statistically significant difference.Chi-square test and multivariate logistic regression analysis were used for statistical analysis.Results The recurrence rate of adenoma was 25.5%(128/501)in three years after operation among 501 patients who underwent colonoscopic resection of colorectal adenoma.There were no statistically significant differences in the recurrence rates among patients with different gender and age(both P>0.05).The recurrence rates of patients with BMI<25,25 to 29 and>29 kg/m^(2) were 19.2%(32/167),27.5%(44/160)and 29.9%(52/174),respectively.And the recurrence rate of patients with BMI>29 kg/m^(2) was higher than that of patients with BMI<25 kg/m^(2),and the difference was statistically significant(χ^(2)=6.978,P<0.05).There were no statistically significant differences in the recurrence rates between patients with BMI<25 kg/m^(2) and 25 to 29 kg/m^(2),between BMI 25 to 29 kg/m^(2) and>29 kg/m^(2)(both P>0.05).The recurrence rate of adenomas in patients who smoked,complicated with NAFLD or diabetes were higher than those of non-smokers,patients without NAFLD or diabetes(32.9%,51/155 vs.22.3%,77/346;27.6%,61/221 vs.23.9%,67/280;31.3%,25/80 vs.24.5%,103/421),and the differences were statistically significant(χ^(2)=8.132,7.232 and 6.874,all P<0.05).The recurrence rates of patients with of adenomas≤5,>5 to<

关 键 词：结直肠腺瘤 复发 内镜下黏膜切除术 内镜黏膜下剥离术 

分 类 号：R735.34[医药卫生—肿瘤]