结直肠侧向发育型肿瘤包括15例多发性病变的临床病理特征及癌变风险因素分析  

Analysis of clinicopathological features and carcinogenesis risk factors of colorectal laterally spreading tumors including 15 cases with multiple lesions

作　　者：吉晓凤 金多晨 党旖旎[1] 张国新[1] JI Xiaofeng;JIN Duochen;DANG Yini;ZHANG Guoxin(Department of Gastroenterology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院消化科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2022年第4期535-541,共7页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家自然科学基金(81970499)。

摘　　要：目的:分析结直肠侧向发育型肿瘤(laterally spreading tumor,LST)包括15例多发性病变的临床病理特征及癌变风险因素。方法:回顾性分析2010年1月—2020年12月在南京医科大学第一附属医院消化内科经结肠镜检查确诊的209例LST患者的临床资料。结果:共222处LST病灶纳入研究,颗粒均一型LST 30处(13.5%),结节混合型LST 64处(28.8%),扁平隆起型LST 118处(53.2%),假凹陷型LST 10处(4.5%)。其中,多发性LST共15处病灶,好发于右半结肠(80.0%,12/15),病理以低级别上皮内瘤变为主(66.7%,10/15),以内镜黏膜下剥离术为主要的治疗手段(60.0%,9/15),有肠息肉病史的患者更易出现多发性LST,多发性LST以颗粒均一型多见,单发性以扁平隆起型多见。多因素Logistic回归分析表明,病灶长径>20 mm和内镜医师年资低(OR=5.074,95%CI:2.011~12.801,P<0.05)是LST癌变的独立风险因素,其中病灶长径≥40 mm(OR=5.468,95%CI:1.792~16.684,P<0.05)癌变风险更高。结论:病灶长径>20 mm和内镜医师年资低是LST癌变的独立风险因素,有肠息肉病史的患者更易出现多发性LST,且以颗粒均一型多见,单发性则以扁平隆起型多见。Objective:To analyze the clinicopathological features and carcinogenesis risk factors of colorectal laterally spreading tumor(LST)including 15 cases with multiple lesions.Methods:The clinical data of 209 patients with LST diagnosed by colonoscopy in the Department of Gastroenterology,the First Affiliated Hospital of Nanjing Medical University from January 2010 to December2020 were retrospectively analyzed.Results:A total of 222 LST were included in the study,including 30(13.5%)LST-G-homogenous type(LST-G-H),64(28.8%)LST-G-mixed type(LST-G-M),118(53.2%)LST-NG-flat elevated type(LST-NG-F)and 10(4.5%)LSTNG-peseudodepressed(LST-NG-PD).A total of 15 multiple LST,occurred in the right colon(80.0%,12/15),the pathology was mainly low-grade dysplasia(66.7%,10/15),with endoscopic submucosal dissection(ESD)as the main treatment(60.0%,9/15).Patients with a history of colon polyps were more likely to appear multiple LST.Multiple LST were more common in LST-G-H type,and single LST were more common in LST-NG-F type.Multivariate Logistic regression analysis showed that the size of lessions>20 mm and the junior endoscopic physicians(OR 5.074,95%CI 2.011~12.801,P<0.05)were independent risk factors for LST carcinogenesis,in which the size of lessions≥40 mm(OR 5.468,95%CI 1.792~16.684,P<0.05)had a higher risk of carcinogenesis.Conclusion:The size of lessions>20 mm and the junior endoscopic physicians were independent risk factors for LST carcinogenesis.Patients with a history of colon polyps were more likely to appear multiple LST.Multiple LST were more common in LST-G-H type,and single LST were more common in LST-NG-F type.

关 键 词：侧向发育型肿瘤 临床病理特征 手术方式 癌变 风险因素 

分 类 号：R735.3[医药卫生—肿瘤]