溃疡性结肠炎相关异型增生和溃疡性结肠炎相关性结直肠癌56例的临床特征  

Clinical characteristics of 56 cases of ulcerative colitis-associated dysplasia and colorectal cancer

作　　者：万健 张玉洁 王敏 梁洁 吴开春 Wan Jian;Zhang Yujie;Wang Min;Liang Jie;Wu Kaichun(Department of Gastroenterology,Xijing Hospital of Digestive Diseases,Air Force Medical University,National Clinical Research Center for Digestive Diseases,Xi′an 710032,China)

机构地区：[1]空军军医大学西京消化病医院消化内科国家消化系统疾病临床医学研究中心,西安710032

出　　处：《中华消化杂志》2021年第10期660-664,共5页Chinese Journal of Digestion

基　　金：国家自然科学基金(81421003、81627807);国家重点研发计划(2017YFC0908300);肿瘤生物学国家重点实验室自主课题(CBSKL2015Z01)。

摘　　要：目的分析溃疡性结肠炎(UC)相关瘤变[包括UC相关异型增生和溃疡性结肠炎相关性结直肠癌(UC-CRC)]患者的临床特征。方法回顾性分析2010年1月至2019年7月就诊于空军军医大学西京消化病医院的56例UC相关瘤变患者的临床资料。将56例UC相关瘤变患者分为低级别异型增生(LGD)组(38例)和进展期瘤变组(18例),进展期瘤变包括高级别异型增生患者5例和UC-CRC患者13例。统计学方法采用Mann-Whitney U检验、卡方检验或Fisher确切概率法。结果UC相关瘤变年龄为(47.4±14.7)岁,病变范围以广泛结肠型为主,占71.4%(40/56),5例(8.9%)患者合并结直肠狭窄。进展期瘤变组病程长于LGD组[10.5年(3.5年,14.5年)比2.0年(1.0年,5.0年)],差异有统计学意义(U=155.000,P=0.001),进展期瘤变组18例患者中有4例合并结直肠狭窄,该比例高于LGD组的2.6%(1/38),差异有统计学意义(Fisher确切概率法,P=0.033)。进展期瘤变组有7例患者为多灶性病变。13例UC-CRC患者中有5例癌变位于直肠,病理类型以中分化腺癌(9例)为主。结论进展期瘤变患者病程长于LGD患者,其合并结直肠狭窄比例高于LGD患者。进展期瘤变患者的多灶性病变比例较高,应加强UC患者的瘤变监测。Objective To analyze the clinical characteristics of patients with ulcerative colitis(UC)-associated neoplasia,including UC-associated dysplasia and ulcerative colitis-associated colorectal cancer(UC-CRC).Methods From January 2010 to July 2019,the clinical data of 56 patients with UC-associated neoplasia at Xijing Hospital of Digestive Diseases were retrospectively analyzed.The patients with UC-associated neoplasia were divided into low-grade dysplasia(LGD)group(38 cases)and advanced neoplasia group(18 cases),the advanced neoplasia group included five patients with high-grade dysplasia and 13 patients with UC-CRC.Mann-Whitney U test,chi-square test and Fisher′s exact test were used for statistical analysis.Results The age of patients with UC-associated neoplasia was(47.4±14.7)years old.The main type of lesion was extensive colitis(71.4%,40/56).There were five patients(8.9%)complicated with colorectal stricture.The disease course of the advanced neoplasia group was longer than that of LGD group(10.5 years,3.5 years to 14.5 years vs.2.0 years,1.0 year to 5.0 years),and the difference was statistically significant(U=155.000,P=0.001).Four of the 18 patients of the advanced neoplasia group had colorectal stricture,the ratio was higher than that of LGD group(2.6%,1/38),and the difference was statistically significant(Fisher exact test,P=0.033).In advanced neoplasia group,there were seven patients with multifocal lesions.Among 13 patients with UC-CRC,the lesions of five patients located in rectum,and the pathological type was mainly moderately differentiated adenocarcinoma(nine cases).Conclusions The disease course of patients with advanced neoplasia is longer than that of patients with LGD,and the proportion of patients complicated with colorectal stricture is higher than that of patients with LGD.The proportion of multifocal lesions in patients with advanced neoplasia is higher,and the surveillance of neoplasia in UC patients should be strengthened.

关 键 词：结肠炎 溃疡性 异型增生 结直肠肿瘤 临床特点 

分 类 号：R574.62[医药卫生—消化系统] R735.34[医药卫生—内科学]