大肠进展期腺瘤性息肉的临床及病理特点分析  

The clinical and pathological characteristics of advanced colorectal adenomatous polyps

作　　者：黄忠[1] 张洁[1] 程芳 候聪[1] 陈新莲[1] HUANG Zhong;ZHANG Jie;CHENG Fang;HOU Cong;CHEN Xinlian(Division of Gastroenterology,Zigong First People's Hospital,Zigong,Sichuan 643000,P.R.China)

机构地区：[1]自贡市第一人民医院消化内科,四川自贡643000

出　　处：《华西医学》2021年第12期1700-1704,共5页West China Medical Journal

摘　　要：目的探讨大肠进展期腺瘤性息肉的临床及病理特征。方法选择2013年1月—2019年3月于自贡市第一人民医院消化内镜中心行结肠镜检查后诊断的大肠腺瘤性息肉患者。将纳入患者分为大肠进展期腺瘤性息肉组(进展期组)和大肠非进展期腺瘤性息肉组(非进展期组)。分析大肠进展期腺瘤性息肉的部位、病理类型及与癌变的关系。结果共纳入患者1 555例。其中,进展期组223例(14.34%),非进展期组1 332例(85.66%)。除术后病理检查癌变情况的部位分布比较差异无统计学意义(P=1.000)外,两组其余指标比较差异均有统计学意义(P<0.05)。进展期组高级别上皮内瘤变检出率,管状腺瘤高于绒毛-管状腺瘤(41.18%vs.13.74%;χ^(2)=18.959,P<0.001);管状腺瘤与绒毛状腺瘤比较,差异无统计学意义(41.18%vs. 25.00%;χ^(2)=1.992,P=0.220)。进展期组分布于右半结肠40例(17.94%),左半结肠183例(82.06%)。在左半结肠的高级别上皮内瘤变检出率中,绒毛状腺瘤分别与绒毛-管状腺瘤(17.65%vs. 14.41%;χ^(2)=2.801,P=0.094)、管状腺瘤(17.65%vs. 41.82%;χ^(2)=3.289,P=0.088)比较,差异均无统计学意义;管状腺瘤高于绒毛-管状腺瘤(41.82%vs. 14.41%;χ^(2)=9.322,P=0.002)。进展期组的管状腺瘤、绒毛-管状腺瘤、绒毛状腺瘤术后病理为癌变的检出率比较,差异无统计学意义(χ^(2)=3.002,P=0.249)。结论当前应重视大肠腺瘤性息肉。内镜医师应掌握大肠进展期腺瘤性息肉的临床及病理特点,以提高进展期腺瘤性息肉及癌变病例的检出率。Objective To investigate the clinical and pathological characteristics of advanced colorectal adenomatous polyps. Methods Patients with colorectal adenomatous polyps diagnosed after colonoscopy in the Division of Gastroenterology of Zigong First People’s Hospital from January 2013 to March 2019 were selected. The patients were divided into advanced colorectal adenomatous polyps group(advanced group) and non advanced colorectal adenomatous polyps group(non advanced group), to analyze the location distribution, pathological type and the relationship with carcinogenesis of advanced colorectal adenomatous polyps. Results A total of 1 555 patients were included. There were 223 cases(14.34%) in the advanced group and 1 332 cases(85.66%) in the non advanced group.There was no significant difference in the distribution of canceration in postoperative pathological examination(P=1.000),but there was significant difference in other indexes between the two groups(P<0.05). The detection rate of high-grade intraepithelial neoplasia in the advanced group was higher in tubular adenoma than that in villous-tubular adenoma(41.18% vs. 13.74%;χ^(2)=18.959, P<0.001). There was no significant difference in the detection rate of high-grade intraepithelial neoplasia between tubular adenoma and villous adenoma(41.18% vs. 25.00%;χ^(2)=1.992, P=0.220). In the advanced group, 40 cases(17.94%) were at the right colon and 183 cases(82.06%) at the left colon. In the detection rate of high-grade intraepithelial neoplasia in the left colon, there was no significant difference between villous adenoma and villous-tubular adenoma(17.65% vs. 14.41%;χ^(2)=2.801, P=0.094) or tubular adenoma(17.65% vs. 41.82%;χ^(2)=3.289, P=0.088);the rate in tubular adenoma was higher than that in villous-tubular adenoma(41.82% vs. 14.41%;χ^(2)=9.322, P=0.002).There was no significant difference in the detection rate of canceration among tubular adenoma, villous-tubular adenoma and villous adenoma in the advanced group(χ2=3.002, P=0.249). Conclusions At presen

关 键 词：腺瘤性息肉 上皮内瘤变 病理学 癌变 

分 类 号：R735.34[医药卫生—肿瘤]