大肠癌合并的大肠息肉临床病理特点

目的结合临床实践经验,探讨总结大肠癌合并的大肠息肉临床病理特点。方法以2006年1月至2009年12月期间,广州市中医医院178例大肠癌和1012例非大肠癌患者为研究对象,对其临床资料进行分析研究,分析比较描述癌变息肉内镜下大小、分布、病理类型肉关系。结果不同大小息肉癌变比例差别有统计学意义(P<0.05),息肉越大出现癌变的可能性越大。结肠不同部位息肉癌变比例的差别有统计学意义(P<0.05)。不同类型息肉癌变比例差别有统计学意义(P<0.05)。结论应重视大肠癌患者出现大肠息肉的状况,及时采取有效治疗措施,从而减少术后肿瘤复发及多源性大肠癌的发生。患者息肉切除后仍存在复发和癌变的可能性,因此,要重视对大肠息肉术后患者的随访,以达到减少癌症的发生与复发的目的。     

便秘病例结肠镜检查及追踪的回顾性分析

目的通过回顾性研究342例便秘病例的初次结肠镜检查结果,并对其中148例进行结肠镜追踪检查,探索便秘和肠道疾病之间的关系。方法总结分析342例便秘病例的结肠镜检查资料及其中已行1～3次结肠镜复查的148例病例的追踪资料。记录接受首次及追踪结肠镜检查的便秘病例的年龄、性别、镜下发现的大肠疾病;记录便秘病例中发现大肠息肉的病理类型、直径、数目。观察不同时间段结肠镜复查时大肠疾病的检出情况,分析便秘与肠道疾病的关系。结果①342例已行结肠镜检查的便秘病例的常见大肠疾病为大肠炎症、大肠息肉、结肠黑变病及大肠癌。②大肠息肉、大肠癌及结肠黑变病在60岁以上病例组检出率高于60岁以下病例组(P<0.05)。③结肠镜检出的大肠息肉中腺瘤性息肉26例(66.67%),男性便秘病例大肠息肉、大肠癌检出率高于女性(P<0.05)。④148例接受结肠镜追踪检查的病例中,便秘病程大于5年组大肠息肉、大肠癌及结肠黑变病检出率高于病程小于5年组(P<0.05)。结论①便秘病例的相关大肠疾病发病率依次为大肠息肉、大肠癌和结肠黑变病。②与60岁以下病例组相比,60岁以上病例组大肠息肉、大肠癌及结肠黑变病发生率较高。③与便秘病程小于5年组相比,便秘病程大于5年组大肠息肉、大肠癌及结肠黑变病发生率较高。     

遗传性非息肉病性大肠癌临床病理特点与预后的关系分析

目的研究遗传性非息肉病性大肠癌的临床病理特点与预后的关系。方法选取2000年1月至2010年6月,在多地通过临床家系调查,筛选出18个遗传性非息肉病性大肠癌家系,其中肿瘤患者共70例,分为典型组(A组)和非典型组(B组),将同期调查中的其余无家族遗传背景的大肠癌68例患者作为对照组(C组)。回顾分析两组的临床病理和随访资料,比较两组的临床病理特点和预后关系差异。结果 A组和B组与C组在性别方面无显著差异,但在发病年龄、肿瘤情况、病理类型和预后方面差异显著。遗传性非息肉病性大肠癌发病年龄早、病理分化不佳、结肠癌和多原发癌常见的特点,但其5年以上的存活率优于无家族遗传背景的大肠癌。结论遗传性非息肉病性大肠癌的临床病理特点明显,与散发性大肠癌生物行为有显著的差异,预后较无家族遗传背景的大肠癌佳。     

南昌市部分人群大肠癌与息肉临床特点调查分析

目的探讨南昌市居民大肠癌与息肉的临床特点。方法选取我院肠道门诊2005年1月至2007年12月就诊的腹泻病例经结肠镜检与病理确诊的大肠癌、息肉患者进行总结分析。结果3年来5073例腹泻患者中共行结肠镜检873例,确诊的大肠癌75例,大肠息肉114例。大肠癌检出率为8.6%,平均发病年龄为64.01岁,好发病年龄为51～70岁,占90.67男∶女为1.6∶1;大肠息肉患者的检出率为13.1%,平均年龄为44.15,男性以61～70岁发病率最高,占18.42%,男∶女为1.65∶1;直、乙结肠是大肠癌与息肉的最常见部位,分别占74.67%和68.42%。结论大肠癌与息肉男性多于女性,直肠和乙状结肠是最常见发生部位。50岁以上的中老年人是大肠癌的高危人群。     

大肠肿瘤危险人群分类检出的研究

目的初步探讨不同危险人群分类的大肠肿瘤检出情况,为预防和治疗大肠癌提供科学依据。方法对所有来笔者所在医院行肠镜检查的患者均采用问卷调查,采用本课题组的人群分类,测量身高、体重,并记录有无糖尿病及病程,分别计算不同人群大肠肿瘤检出情况。结果 2009年1月~2011年12月行大肠镜检查符合纳入条件者1 035例,根据肠镜检查及活检病理结果,共检出大肠腺瘤86例、大肠息肉106例和大肠癌69例。大肠肿瘤(大肠腺瘤+大肠息肉+大肠癌)总的检出率为25.2%(261例),其中高危人群大肠肿瘤检出率为42.2%(111/263),中危人群检出率为25.4%(48/189),低危人群检出率为23.1%(83/359),普通人群大肠肿瘤检出率为8.5%(19/224)。不同人群间检出率比较显示,高危人群大肠肿瘤检出率高于其他组,差异有统计学意义(P<0.05);低危人群组与中危人群组大肠肿瘤检出率比较,差异无统计学差异(P>0.05)。结论筛查并发现大肠肿瘤的高危人群,及时加以干预,有利于降低大肠癌的发病率及死亡率。     

子宫内膜息肉发生与患者妇科疾病史的关系研究

目的 探讨子宫内膜息肉(EP)发生与患者妇科疾病史的关系.方法 分析2014年3月至2016年3月在本院妇科行宫腔镜检查的516例住院患者的病历资料,174例病理检查提示为EP作为EP组,342例病理检查结果为非EP作为非EP组,记录患者的临床资料并行单因素和多因素发分析.结果 EP组年龄高于非EP组,孕次少于非EP组,出现绝经、子宫腺肌症、宫颈息肉、糖尿病、高血压的几率高于非EP组,差异有统计学意义(P＜0.05).Logistic回归分析结果显示,绝经、不孕史、孕次减少、子宫腺肌症、宫颈息肉是EP发生的独立危险因素.结论 子宫腺肌症、宫颈息肉两种妇科疾病史、孕次减少和绝经是EP发生的独立危险因素.     

大肠息肉的临床特点与息肉恶变相关性分析

目的：探讨大肠息肉的临床特点与息肉恶变的相关性分析。方法选取2006年3月～2014年1月使用内镜中心电子结肠镜所检测大肠息肉患者1482例的资料，根据患者的年龄、部位、病理类型和大小及恶变程度来分析大肠息肉的临床特点与息肉恶变的联系。结果大肠息肉恶变率占4.9%。大肠息肉恶变多发生于男性，发病年龄多在40岁左右，病变部位主要发生在直、乙状结肠；随着息肉的增多，恶变率增加；不同病理类型息肉恶变率不同。结论不同病理类型大肠息肉所表现的临床特点不同，有助于早期诊断大肠息肉的性质，及时地进行干预及治疗，降低大肠癌的发病率。     

医共体模式下大肠癌筛查在基层医院开展的价值研究

目的探讨大肠癌筛查在基层医院开展的应用价值。方法选取湖州第一人民医院医共体埭溪镇中心卫生院所属11个社区卫生服务站2019年8月至2021年6月该地区大肠癌筛查阳性744例患者为观察对象, 患者均行结肠镜检查, 并与活检病理检查对照, 分析最终结果。结果经结肠镜诊断大肠癌27例, 检出率3.62%;检出结肠息肉398例, 息肉检出率53.49%, 好发于60岁以上人群。大肠癌中直肠癌发病率为29.6%, 病理类型腺癌占比(62.90%)最高;大肠息肉检测出腺瘤278例, 腺瘤性息肉检出率37.37%。结论基层医院进行大肠癌早期筛查结合结肠镜检查是发现大肠肿瘤最有效的方法, 能够尽早发现大肠癌, 实现尽早治疗。     

胃与大肠癌家系调查的结果比较

遗传性非息肉病性大肠癌（hereditary nonpolyposis colorectal cancer，HNPCC）因其遗传病因特殊和临床病理特点突出成为大肠癌研究的一个热点。依据是否伴发大肠外肿瘤，HNPCC分为两种临床亚型。目前认为胃癌是HNPCC最常见大肠外肿瘤之一。现将我院2001年1月-2005年12月收治并手术的胃癌与大肠癌患者的家系调查资料进行总结分析，以了解胃癌与大肠癌家族遗传背景及差异情况，提高诊断治疗水平。     

106例老年人大肠息肉的内镜治疗

大肠癌绝大多数是由息肉恶变而来,早期发现大肠息肉并及时治疗,是改善大肠癌预后的有效途径。我院近10年来(1992年1月至2001年12月)内镜治疗大肠息肉共365例,其中60岁以上的老年患者106例,占29．04％,现分析总结如下。     

Pharmacogenetics of colorectal cancer

Colorectal cancer is one of the most common types of cancer in both men and women. Multiple chemotherapy combinations exist; however, there is currently no strategy for individualised therapy selection prior to treatment. Genetic polymorphisms in genes involved in the metabolism, transport or targets for the commonly used chemotherapy drugs (5-fluorouracil, irinotecan and oxaliplatin) have been described. Many require validation in large prospective trials before they can be used as markers for outcome and/or toxicity. This review describes the data available on polymorphisms in key genes that are associated with chemotherapy toxicity and response in colorectal cancer.     

Nutrition and colorectal cancer

Diet plays an important role in the pathogenesis of colorectal cancer. Current prospective cohort studies and metaanalysis enable a reevaluation of how food or nutrients such as fiber and fat influence cancer risk. Based on the evidence criteria of the WHO/FAD, risk reduction by a high intake of fruit is assessed as possible, while a lowered risk by a high vegetable intake is probable. Especially raw vegetables and fruits seem to exert anticancer properties. The evidence of a risk reducing effect of whole grain relating to colorectal cancer is assessed as probable whereas the evidence of an increased risk by high consumption of refined white flour products and sweets is (still) insufficient despite some evidences. There is a probable risk reducing effect of milk and dairy products. e available data on eggs and red meat indicate a possible risk increasing influence. Stronger clues for a risk increasing effect have been shown for meat products leading to an evidence assessed as probable. Owing to varied interpretations of the data on fiber, the evidence of a risk reducing effect relating to colorectal cancer is assessed as possible or insufficient. The available data on alcohol consumption indicate a possible risk increasing effect. In contrast to former evaluations, diets rich in fat seem to increase colorectal cancer risk only indirectly as part of a hypercaloric diet by advancing the obesity risk. Thus, the evidence of obesity, especially visceral obesity, as a risk of colorectal cancer is judged as convincing today. Prospective cohort studies suggest that people who get higher than average amounts of folic acid from multivitamin supplements have lower risks of colorectal cancer. The evidence for a risk reducing effect of calcium, selenium, vitamin D and vitamin E on colorectal cancer is insufficient. As primary prevention, a diet rich in vegetables, fruits, whole grain products, and legumes added by low-fat dairy products, fish, and poultry can be recommended. In contrast the consumption of sweets, refined white flour products and meat products should be reduced.     

Pharmacogenetics of colorectal cancer

Colorectal cancer is one of the most common types of cancer in both men and women. Multiple chemotherapy combinations exist; however, there is currently no strategy for individualised therapy selection prior to treatment. Genetic polymorphisms in genes involved in the metabolism, transport or targets for the commonly used chemotherapy drugs (5-fluorouracil, irinotecan and oxaliplatin) have been described. Many require validation in large prospective trials before they can be used as markers for outcome and/or toxicity. This review describes the data available on polymorphisms in key genes that are associated with chemotherapy toxicity and response in colorectal cancer.     

Epirubicin in colorectal cancer

Summary Epirubicin, a stereoisomer of doxorubicin with suggested lower potential for cardiotoxicity in experimental animal tumor systems, was studied in a disease-oriented phase II trial in patients with advanced colorectal cancer. The drug was given as a direct iv injection of 90 mg/m² q 3 weeks. No objective response was observed in 52 evaluable patients with colon (n = 34) and rectal (n = 18) carcinoma. Fourteen patients (27%) had stable disease for a median of four treatment courses. Leukopenia (88%), nausea and vomiting (71%) and alopecia (54%) were the most common toxic effects.We conclude that epirubicin at the present dose and schedule is an ineffective agent in patients with metastatic colorectal cancer.