老年人与中青年人大肠息肉临床特点对比研究

目的探索老年人大肠息肉的临床特征。方法收集在上海中医药大学附属曙光医院2006年1月-2019年12月行电子结肠镜检查并且病理证实为大肠息肉的患者1000例,进行回顾性研究,按年龄分为老年组576例,中青年组424例。统计分析老年大肠息肉患者的临床症状、息肉大小、形态、部位、数目、息肉病理分型及其与息肉癌变的相关性,同时与中青年组比较。结果老年组最常见的临床表现为便血或粪隐血阳性(48.1%)及腹胀(45.8%),中青年组主要表现为腹胀(26.7%)和便秘(25.7%);2组患者均以无蒂、多发息肉多见,左半结肠是息肉好发部位;2组均以<2 cm的息肉多见;老年组≥2 cm的息肉多于中青年组(6.2%vs 3.6%,P=0.008);2组病理分型均以管状腺瘤为主,老年组管状绒毛状腺瘤比例高于中青年组(12.6%vs 7.6%,P=0.000);癌变率男女性间无差异;老年组息肉癌变率高于中青年组(9.7%vs 4.7%,P=0.004),左半结肠息肉、无蒂息肉、绒毛状腺瘤、>2 cm息肉癌变率高;老年组<2 cm息肉癌变率高于中青组(2.4%vs 1.0%,P=0.014)。结论腹胀、便血或粪隐血阳性是老年大肠息肉患者常见临床表现,老年患者大肠息肉癌变率高于中青年患者,大肠息肉的癌变率与年龄、息肉大小、部位、病理分型密切相关。     

老年人大肠息肉无痛结肠镜切除术结肠镜结果分析

目的探讨无痛结肠镜下老年人大肠息肉切除术后病理及镜下特点。方法回顾性分析117例老年人大肠息肉的临床资料、内镜和病理特点,分析老年患者息肉的病理学、内镜特点（分布、大小、形态）及癌变情况,并与同期中青年患者进行比较。结果所有人群的息肉均好发于左半结肠（直肠、乙状结肠、降结肠）;老年患者息肉检出率高于中青年患者（35.67%vs 9.50%）（P〈0.01）;老年人息肉以腺瘤性息肉最为多见（60.71%）,息肉癌变率高（4.29%）,均高于中青年组（P〈0.05）;老年组直径≥1 cm的息肉和分叶状息肉也多于中青年组（P〈0.05）。结论肿瘤大小、病理类型、发生部位和年龄为腺瘤发生不典型增生的4个最重要的风险因子,老年大肠息肉患者具有以上危险因素。对老年人大肠息肉应该遵循＂见瘤即切＂的原则并密切随访。     

无痛结肠镜切除老年大肠息肉的疗效

目的探讨无痛结肠镜治疗老年大肠息肉的临床效果。方法回顾性分析经无痛结肠镜切除治疗的162例老年(≥60岁)大肠息肉患者的临床资料,分析治疗效果、病理学、内镜特点、癌变情况,并与同期130例中青年大肠息肉患者进行比较。将老年患者按照年龄分为60~65岁组、66~70岁组、71~75岁组和≥76岁组,分析不同年龄组大肠息肉病理特点。结果老年组共检出大肠息肉270枚,中青年组共检出222枚,两组均以乙状结肠处大肠息肉数量最多,回盲部最少。两组大肠息肉分布及各部位癌变比例比较差异无统计学意义(P>0.05)。老年组与中青年组在息肉大小、息肉基底情况和息肉形态等方面差异有统计学意义(P<0.05),老年组患者息肉≥1 cm以上、广基息肉、分叶息肉比例显著高于中青年组(P<0.05)。老年组患者管状腺瘤比例显著高于中青年组,炎性息肉比例显著低于中青年组(P<0.05),两组患者其余类型息肉比例差异无统计学意义(P>0.05)。各年龄段老年患者大肠息肉病理类型稍有差异,60~65岁组以炎性息肉比例最高,且显著高于其余三组(P<0.05);66~70岁组、70~75岁组和≥76岁组均以管状腺瘤比例最高。结论老年组大肠息肉患者与中青年患者在息肉大小、息肉基底情况、息肉形态、腺瘤性息肉比例等方面差异显著,老年患者发生结直肠癌的风险高,应对发现的老年大肠息肉患者进行积极摘除治疗,以降低癌变发生率。     

尼龙绳套扎加高频电凝切除术治疗老年大肠带蒂息肉的疗效

目的探讨尼龙绳套扎加高频电凝切除术治疗老年大肠带蒂息肉的安全性与疗效。方法选择经结肠镜检查发现大肠息肉直径≥1 cm蒂部直径>0.8 cm带蒂息肉患者113例,共123枚息肉,均在内镜中心行尼龙绳套扎加高频电凝切除术,根据年龄分成老年组及青中年组,其中老年组42例,息肉50枚;青中年组71例,息肉73枚。观察两组息肉的好发部位、息肉性质、经内镜治疗后发生并发症的情况。结果两组息肉好发部位均位于乙状结肠,均在内镜下成功切除,其中青中年组3例发生术中少量出血,两组其他患者均未发生术中内镜下不可控制出血、术后出血及穿孔等并发症。术后病理发现老年组低级别上皮内瘤变发病率高于青中年组(P<0.05)。结论尼龙绳套扎加高频电凝切除术治疗老年大肠带蒂息肉创伤小且安全、有效、经济。     

老年组与青年组肠息肉内镜治疗临床观察

目的探讨老年患者与青年患者大肠息肉的发病特点,对比内镜下治疗方法及效果。方法采用随机法,共抽取2014年11月-2015年11月,我院消化内科收录的100例大肠息肉患者资料,对内镜下检查大肠息肉效果回顾性分析。本次采用分组法,老年组、中青年组,每组50例;经过内镜检查与治疗分析,对比2组患者大肠息肉数量、部位、大小;术后并发症、切除方式、平均住院时间等;为临床治疗分析提供可靠的依据。结果本次100例分组观察发现,大肠息肉多发于男性患者,女性患者占少数;中青年男性肠息肉比例大于老年组;老年组合并症人数大于中青年组;老年组肠息肉枚数多于中青年组,直径大小在1.0cm-2.0cm;2组患者在手术方式、术后并发症、平均住院时间等方面,对比无显著差异(P0.05)。结论老年患者与中青年患者身体组织差异明显,大肠息肉病症状态有明显区别,临床治疗需拟定针对性治疗方案。     

结肠息肉的病理特点与年龄、性别关系研究

[目的]探讨不同性别及不同年龄段大肠息肉的发生部位、大小及病理分型等生物学特点。[方法]随机选取我院2010年1月~2016年4月收治的1 000例经电子胃肠镜确诊并行内镜下息肉切除术的患者,根据年龄段分为中青年组(60岁)与老年组(≥60岁),分析大肠息肉的发生部位、大小及病理分型等生物学特点,在不同性别及不同年龄段的分布情况。[结果]在结肠息肉发生部位上,随着年龄的增大,远端结肠息肉的出现率随之增高,即中青年出现率小于老年出现率,差异有统计学意义(P0.05);在远端结肠发生率上,老年组高于中青年组,差异有统计学意义(P0.05);在结肠息肉大小上,中青年组在直径0.5~1.0cm的息肉枚数上明显高于老年组,差异有统计学意义(P0.05);腺瘤性息肉包含管状腺瘤,2组患者所有病理类型中管状腺瘤的发病率是最高的,2组患者腺瘤性息肉的出现率均明显高于其他病理类型息肉的出现率,但差异无统计学意义(P0.05);年轻女性结肠息肉的出现率明显低于年老女性,差异有统计学意义(P0.05),年轻男性结肠息肉的出现率则高于老年男性,差异有统计学意义(P0.05)。[结论]不同年龄组大肠息肉的临床及病理特点不同,应根据不同的年龄段采取不同的临床诊疗方案。     

老年人与中青年人大肠不同肠段息肉与腺瘤检出率相关性分析

[目的]探讨老年人及中青年人大肠中不同肠段的息肉检出率与腺瘤检出率之间的关系,为个体内镜医师改善不同肠段的结肠镜检查效率提供数据支持。[方法]回顾性分析9名个体内镜医师2013年1月~2013年6月共进行的2 419例结肠镜检查及病理资料,其中老年组（≥60岁）453例,中青年人组（〈60岁）1 966例;按照不同年龄、不同肠段分别计算9名内镜医师平均息肉检出率和腺瘤检出率,并使用皮尔逊相关系数（r）比较息肉检出率与腺瘤检出率之间的相关性。[结果]老年组平均息肉、腺瘤检出率（53.9%、30.1%）均高于中青年组平均息肉、腺瘤检出率（38.5%、19.5%）。与右半结肠比较,中青年组左半结肠各肠段的息肉检出率与腺瘤检出率更具良好的相关性。老年组回盲部（r=0.66,P〈0.05）、乙状结肠（r=0.77,P〈0.05）及直肠（r=0.47,P〈0.05）的息肉检出率与腺瘤检出率相关性较低;老年组左半结肠的腺瘤检出率（21.8%）与近端结肠（20.3%）无明显差别。[结论]我们应该提高对大肠不同肠段息肉、腺瘤检出率的关注程度;应适当放宽老年人进行结肠镜检查的适应证,提倡老年人尽量进行结肠镜检查,减少腺瘤性息肉癌变的机会,并加强老年人结肠镜检查质量。     

内镜下黏膜切除术治疗老年人大肠息肉

目的 研究内镜下黏膜切除术(EMR)对老年人大肠息肉的治疗效果,并对其临床病理特征、适应证、并发症等进行讨论.方法 2003年10月至2008年10月共完成老年人大肠息肉EMR手术277例,共计413枚.对切除标本进行病理组织学观察,术后定期内镜随访1～60月,以评价切除效果,记录术中及术后发生的并发症及处理情况.结果 413枚息肉中393枚经首次或再次EMR治疗病变完整清除,治愈率为95.2%;15枚(占3.6%,15例患者)术后病理示浸润癌再追加外科开腹手术.术中出血16例(5.8%),均内镜下止血成功;术后迟发出血5例(1.8%),其中3例经内镜下止血成功,2例经输血及内科保守治疗后出血停止.无穿孔、感染及其他并发症发生.病理结果示炎性息肉、增生性息肉、腺瘤性息肉、腺瘤癌变分别占25.7%(106/413),19.1%(79/413),50.4%(208/413),4.8%(20/413),老年人随着年龄的增加,腺瘤性息肉的比例逐渐升高(P＜0.01).随访期间所有病例均无复发.结论 EMR是一种安全和微创的内镜治疗手段,对老年人大肠息肉治疗的效果优于传统的内镜下治疗方法.     

老年人大肠息肉内镜治疗106例

目的:探讨内镜治疗老年人大肠息肉的方法及价值.方法:通过对106例老年人大肠息肉的内镜治疗,研究老年患者大肠息肉的内镜和病理特征以及内镜治疗和随访的体会.结果:106例老年患者男65例,女41例,年龄60-87岁,平均69.4岁,伴随其他器官疾病23例,占21.7%;106例患者中共检出息肉213颗,息肉主要分布在直肠和乙状结肠(64.3%),次为升结肠和回盲部(15%);多发及带蒂息肉分别约占1/3,息肉直径大于2cm占21.1%,息肉与癌并存占11.3%;病理检查癌变率占腺瘤的27.9%,增生性息肉和炎性息肉无一例癌变;癌变的息肉除一例外直径均大于2cm.内镜下治疗手术成功率达100%,术中并发出血一例,并发症发生率占0.9%.术后有72例患者随访,随访率达67.9%,息肉复发率为29.2%,复发的息肉腺瘤.结论:(1)内镜下摘除息肉创伤小,安全有效且能反复应用,特别适合于老年人.本组老年患者有21.3%伴有其他器官疾病,术中均能耐受,术中及术后其合并症无加重现象.(2)息肉分肿瘤性(腺瘤)和非肿瘤性息肉,腺瘤是公认的癌前期病变,老年人大肠息肉以腺瘤居多,本组病例占57.5%,且癌变率高达27.9%,摘除腺瘤打断了腺瘤—腺癌的序贯过程,因此,可有效的降低大肠癌的发生率.(3)本组病例术后随访中息肉复发率为29.2%,复发的息肉中85.7%为腺瘤,且有一例息肉癌变,因此,腺瘤样息肉切除后定期结肠镜复查是很有必要的,他对预防大肠癌的再发生有很重要的作用.(4)我们认为对老年患者在结肠下作息肉摘除术,术前必须处理好其基础疾病合并症,充分的肠道术前准备是手术成功的前题,操作者技术熟练、动作轻柔是手术成功和减少及避免并发症的关键,术后加强护理也是必不可少的条件.     

内镜分光比色染色技术对老年人大肠黏膜隆起性病变的诊断价值探讨

大肠黏膜隆起性病变80％以上是腺瘤性或增生性息肉。大肠息肉是老年人的一种常见疾病,因其临床特点、癌变率及组织学类型与中青年人不同。在诊断老年人大肠息肉时需选取适当的内镜检查。本研究初步探讨了应用内镜分光比色技术（FICE）的放大内镜对老年人大肠黏膜隆起性病变的诊断价值。     

Heparin bridge therapy and post-polypectomy bleeding

AIM To identify risk factors for post-polypectomy bleeding(PPB), focusing on antithrombotic agents. METHODS This was a case-control study based on medical records at a single center. PPB was defined as bleeding that occurred 6 h to 10 d after colonoscopic polypectomy and required endoscopic hemostasis. As risk factors for PPB, patient-related factors including anticoagulants, antiplatelets and heparin bridge therapy as well as polyp- and procedure-related factors were evaluated. All colonoscopic hot polypectomies, endoscopic mucosal resections and endoscopic submucosal dissections performed between January 2011 and December 2014 were reviewed. RESULTS PPB occurred in 29(3.7%) of 788 polypectomies performed during the study period. Antiplatelet or anticoagulant agents were prescribed for 210(26.6%)patients and were ceased before polypectomy except for aspirin and cilostazol in 19 cases. Bridging therapy using intravenous unfractionated heparin was adopted for 73 patients. The univariate analysis revealed that anticoagulants, heparin bridge, and anticoagulants plus heparin bridge were significantly associated with PPB(P 0.0001) whereas antiplatelets and antiplatelets plus heparin were not. None of the other factors including age, gender, location, size, shape, number of resected polyps, prophylactic clipping and resection method were correlated with PPB. The multivariate analysis demonstrated that anticoagulants and anticoagulants plus heparin bridge therapy were significant risk factors for PPB(P 0.0001). Of the 29 PPB cases, 4 required transfusions and none required surgery. A thromboembolic event occurred in a patient who took anticoagulant. CONCLUSION Patients taking anticoagulants have an increased risk of PPB, even if the anticoagulants are interrupted before polypectomy. Heparin-bridge therapy might be responsible for the increased PPB in patients taking anticoagulants.     

老年人大肠息肉与大肠癌

为了解老年人大肠息肉和大肠癌的临床特点，更好地预防老年人大肠肿瘤的发生和早期诊断大肠癌，对２４８例老年人大肠息肉和大肠癌的临床及病理作一回顾性分析。结果老年人大肠息肉和大肠癌的检出率分别为３３．３％和２３．３％，并有以下特点：（１）大肠息肉和大肠癌是老年人便血的主要原因，炎性息肉、腺瘤性息肉及大肠癌三者的便血率依次增高；（２）息肉检出率显著高于普通人群息肉检出率，且腺瘤性息肉占７３．８％；（３）多发性息肉比例较高，并以腺瘤性息肉为主，占８０．７％，且多发生于不同的肠段；（４）老年人大肠癌低恶性程度者多；（５）大肠腺瘤性息肉常与大肠癌并存，二者多发生于不同肠段。因此，我们认为便血是老年人大肠镜检查的有力指征；大肠镜检查时不应满足于远端大肠病变的诊断，应尽可能检查全大肠；对老年人大肠息肉，尤其是多发性息肉及直径大于１．０ｃｍ者应积极切除。     

下呼吸道痰痂分类及其清除术

探讨下呼吸道痰痂形态、治疗。通过支气管镜观察，探求４例开胸术后急性呼吸衰竭的病人在气管切开后，痰痂依形态可分为：扁平型和隆起型。依其与气道壁附着的牢固程度可分为：牢固型和非牢固型。纤维支气管镜直视下清除痰痂有三种方法：吸除，活检钳清除，弯止血钳取除。三种方法中以弯止血钳取除的效率最高，耗时最少。     

Differences in characteristics of colorectal neoplasm between young and elderly Thais

INTRODUCTIONColorectal cancer is one of the most common cancers worldwide. It is also the most frequent form of cancers among elderly population[1]. In contrast, colorectal cancer is considered to be a rare disease in people younger than 40 years of age[2…     

Feasibility of colonoscopy in patients 80 years of age and older

BACKGROUND/AIMS: In Japan, studies on the use of colonoscopy in the elderly population are few. This study evaluated tolerance and diagnostic yield of colonoscopy in elderly patients. METHODOLOGY: We prospectively studied 515 consecutive colonoscopies performed over a 23-month period. A total of 110 patients 80 years of age or older who underwent colonoscopy from May 2003 to March 2005 were studied. We analyzed the following factors: indications for colonoscopy, endoscopic findings, total colonoscopy rates, and complications. RESULTS: Of the 515 procedures performed, 405 (78.6%) in patients less than 80 years of age (265 men, 140 women; median age 64 years, range 18-79 years), and 110 (21.4%) were in patients aged 80 years or older (62 men, 48 women; median age 83 years, range 80-94 years). The percentage of positive fecal occult blood test in younger patient group is high, and rectal bleeding is frequent in older patient group. There was a significantly higher frequency of colorectal cancer in the elder patients (p=0.04). There was no significant difference in total colonoscopy completion rate between the two groups. Two patients in younger group had delayed bleeding, and post-polypectomy bleeding occurred in one patient in elder group. CONCLUSIONS: Colonoscopy in patients 80 or more years of age is safe, effective, and has a high diagnostic yield.     

Incidence and risk factors of delayed postpolypectomy bleeding in patients with chronic liver disease

Objective Hepatologists and colonoscopists often hesitate to perform a colonoscopic polypectomy in patients with chronic liver disease (CLD), especially those with cirrhosis, because of the risk of postpolypectomy bleeding (PPB). We aimed to investigate the incidence and risk factors of delayed PPB after a colonoscopic polypectomy in patients with CLD. Materials and methods In total, 152 patients with CLD who underwent colonoscopic polypectomy from December 2005 to December 2012 were retrospectively reviewed. Results Cirrhosis was identified in 80 (52.6%) patients. During the study period, 442 polyps were removed and delayed PPB developed in 14 (9.2%) patients. The incidence of delayed PPB was significantly higher in patients with cirrhosis than in those without the disease (13.8% [n?=?11] vs. 4.2% [n?=?3], p?=?0.041). The polyp size (odds ratio, 1.087; 95% confidence interval, 1.009–1.172) and cirrhosis (odds ratio, 8.535; 95% confidence interval, 2.417–30.140) were independent risk factors for delayed PPB. In patients with cirrhosis, the optimal cut-off size to identify high-risk polyps for delayed PPB was 10 mm (area under the receiver operating characteristics curve, 0.737; sensitivity, 52%; specificity, 88%). Conclusion Caution is needed when colonoscopic polypectomy is planned in patients with CLD who have larger polyps and cirrhosis.     

老年便秘患者350例肠镜结果分析

目的探讨老年便秘患者和内镜下发现的肠道疾病之间的关系。方法归纳上海中医药大学附属曙光医院2009年7月至2013年7月350例老年便秘病例的结肠镜结果,结合老年便秘患者病程、性别并归纳分析镜下肠道疾病的分布特点。结果350例老年便秘病例肠道疾病发现率高达60．86％,相关大肠疾病发病率依次为结直肠炎（26．86％）、结肠黑变病（13．14％）、肠息肉（12．00％）、结直肠癌（6．57％）、炎症性肠病（1．14％）、结肠憩室（0．57％）、肠结核（0．29％）、毛细血管扩张症（0．29％）。男性便秘病例肠息肉、结直肠癌检出率高于女性（P〈0．05）。便秘病程〉5年组结肠黑变病发生率较高（P〈0．05）。结论老年人便秘的最主要病因是结直肠疾病,尽早行结肠镜检查,明确病因,对症治疗,是提高老年人生活质量的关键。     

老年人大肠息肉的临床分析

目的 探讨老年人大肠息肉的临床特点及其与癌变的关系。方法 对我院经结肠镜检出的158例老年大肠息肉患者的临床特点进行回顾性分析，对其中120例进行1－6年（平均4．5年）的结肠镜随访，并与青中年组的437例患者相对照。结果 老年人大肠息肉的检出率、癌变率分别为30．0％及23．4％，均显著高于中青年组的10．2％及6．9％（P＜0．01），随年龄增长检出率有逐渐增加的趋势。分布以直肠和乙状结肠多见，但升结肠的癌变率（37．5％）明显高于左半结肠（14．3％，P＜0．05），且直肠、降结肠、横结肠及升结肠的癌变率也显著高于青中年组的同一部位（P＜0．01）；病理类型以腺瘤性息肉为多，占77．6％，也明显高于青中年组的同一病理类型（P＜0．01）。37例癌变息肉均为腺瘤性息肉，其中绒毛状腺瘤的癌变率（56．9％）显著高于管状腺瘤（3．4％，P＜0．01）。息肉体积大（＞2cm)、基底宽、数量多，癌变率高。腺瘤性息肉经内镜下摘除者其癌变率明显低于未摘除者（P＜0．01）。结论 老年人大肠息肉中的腺瘤性息肉的大小、形态、数量及病理类型是其癌变的主要危险因素，老年人应尽量行全结肠检查，检出大肠息肉者应尽可能首选肠镜下摘除，定期随访，减少癌变的机会。     

Capsule endoscopy findings in patients with occult or overt bleeding older than 80 years

Background: Overt and occult bleeding are the main indications for a wireless capsule endoscopy (WCE) study of the small bowel. Most published studies omit patients aged over 80. Aim: To determine whether WCE is feasible in patients with overt or occult bleeding over age 80 and to define the spectrum of small bowel pathologies in this age group. Patients and Methods: In a retrospective non‐randomized tertiary care study, 60 patients at least 80 years or older (aged group) and 120 matched patients aged <80 years (younger group) with overt or occult bleeding (including iron deficiency anaemia) and no significant gastroscopic or colonoscopic findings underwent WCE. Results: Of the 180 patients, 46 (77%) patients in the aged group and 97 (81%) in the younger group successfully completed small bowel study (P = 0.51). There was no difference in gastric transit time and small bowel passing time between the two groups. More patients in the aged group (48 cases, 80%) than the younger group (56 cases, 47%) presented with small bowel angiodysplasias (P < 0.0001). Nevertheless, there was no difference between the two groups concerning ulcerative and neoplastic lesions. No patient presented with capsule impaction, but more patients in the aged group (35 cases, 58%) than in the younger group (10 cases, 8%) found the study difficult and tiresome (P < 0.001). Preparation validation was poor in 34% of small bowel lumen in the aged group and 19% in the younger group (P = 0.03). Conclusion: WCE is feasible, although rather tiresome, in patients over the age of 80. Though the vast majority of patients older than 80 presented with angiodysplasias, there were no differences between the aged and younger groups in the presence of ulcerative lesions and polyps or tumors.     

1154例75岁及以上老年患者结肠镜检查及监测的回顾性研究

目的分析75岁及以上的患者结肠镜检查的临床特点,探讨75岁及以上的老年患者定期结肠镜检查的临床价值。方法回顾性研究,纳入2015年1月至2018年3月在广东省人民医院行结肠镜检查的75岁及以上的患者1154例,根据年龄分为75~79岁组605例、80~89岁组527例、90岁以上组22例。分析结肠镜下病变检出情况,每年1次结肠镜检查对75岁及以上老年患者的结直肠病变检出的影响及定期监测的必要性。结果1154例患者,无痛肠镜检查569例(49.3%),普通肠镜检查585例(50.7%),总阳性检出率为83.4%(962/1154),最主要的病变为息肉858例(74.4%),其中腺瘤605例(52.4%)。3个年龄组比较,消化道出血是90岁以上组结肠镜检查者的主要就诊原因,腹部不适、肿瘤免疫指标升高、非肠癌恶性肿瘤史是75~79岁组结肠镜检查者的主要就诊原因(P<0.05)。153例患者参与每年1次的结肠镜检查,第二次复查息肉和腺瘤检出率下降,但仍高于40.0%。结论结肠镜检查是75岁及以上的老年患者安全有效的检查方法,息肉和腺瘤是最常见的病变,结直肠癌和息肉切除术后再发息肉常见,有必要定期复查结肠镜。