左半结直肠癌根治术后锯齿状腺瘤的发生率及危险因素分析  

Incidence and Risk Factors of Sessile Serrated Adenoma after Radical Resection of Left Colorectal Cancer

作　　者：董天增 张莉荣 DONG Tian-zeng;ZHANG Li-rong(Emergency Department,Handan People's Hospital,Handan(056001),China)

机构地区：[1]邯郸市人民医院急诊科,河北邯郸056001 [2]冀中能源峰峰集团有限公司总医院神经内科,河北邯郸056200

出　　处：《中国中西医结合外科杂志》2022年第6期813-817,共5页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

基　　金：2019年度河北省医学科学研究课题计划(20191831)。

摘　　要：目的:探讨左半结直肠癌根治术后锯齿状腺瘤(SSA)的发生率及危险因素。方法:回顾性分析2011年9月—2016年9月我院收治的270例左半结肠癌和直肠癌手术患者为研究对象,术后进行了至少2次结肠镜随访。收集患者基线特征、SSA病理资料及结肠镜检查结果。结果:第1次结肠镜检查平均随访时间为11.5个月,第2次平均随访时间为25.8个月。在第1次随访时,59例患者(21.8%)发现了48枚SSA。在第2次随访中,63例患者(23.3%)发现了40枚SSA。88枚SSA在内窥镜检查中,49枚(55.68%,49/88)表现为扁平状、31枚(35.23%,31/88)表现为半球形隆起、8枚(9.09%,9/88)表现为亚蒂。直径介于2.8~40.0 mm,其中,最大径<5 mm者61枚(69.32%),5~10 mm者19枚(21.59%),>10 mm者8枚(9.09%)。多因素分析显示,体质量指数大、饮酒、TNM分期高及分化程度低是影响患者术后首次结肠镜检查时并发SSA的独立危险因素。结论:左半结直肠癌根治术后无蒂锯齿状腺瘤的发生率较高,特别是肥胖、饮酒、TNMⅢ期、肿瘤低分化患者更易并发SSA。Objective To investigate the incidence and risk factors of sessile serrated adenoma(SSA)after radical resection of left colorectal cancer. Methods 270 patients with left colon cancer and rectal cancer treated in our hospital from September 2011 to September 2016 were analyzed retrospectively. At least 2 colonoscopic follow-up were carried out after operation. The baseline characteristics, SSA pathological data and colonoscopy information were collected. Results The average follow-up time of the first colonoscopy was 11.5 months and that of the second was 25.8 months. At the first follow-up, 48 SSAs were found in 59patients(21.8%). At the second follow-up, 40 SSAs were found in 63 patients(23.3%). Among 88 SSAs, 49cases showed flat and 31 cases showed hemispherical eminence. The diameter ranged from 2.8mm to 40.0mm,of which 61 cases were less than 5mm, 19 cases were 5~10mm and 8 cases were more than 10mm. The BMI,alcohol consumption, TNM stage and degree of differentiation were independent risk factors for SSA during the first postoperative colonoscopy. Conclusion The incidence of sessile serrated adenoma after radical resection of left colorectal cancer is high, especially in patients with obesity, alcohol consumption, TNM stage Ⅲ and low tumor differentiation.

关 键 词：结肠癌 直肠癌 锯齿状腺瘤 肠镜 

分 类 号：R735.3[医药卫生—肿瘤]