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。     

结肠镜下摘除小儿大肠息肉的体会

我院15年间进行结肠镜检查8000例，其中10岁以下188例，检出大肠息肉103例，在结肠镜下电凝切除息肉98例，活检钳夹除5例，共切下息肉112颗，现总结报告如下。     

高频电摘除大肠息肉651例报告

１９９３～１９９８年,我院应用高频电圈套器和热活检钳在结肠镜下摘除大肠息肉６５１例,疗效满意。 １ 一般资料：本组男４３２例,女２１９例,男女之比为１．９７：１。年龄４～８１岁,平均年龄４６．９７岁。其中６０岁以上１４９例,占２２．９％。 ２　临床表现：便血及粘液血便２２８例（３５．１％）,腹泻２０９例（３２．１％）,大便习惯改变１８４例（２８．３％）,大便形状改变１８例（２．８％）,大肠癌术后随访查出息肉１２例（１．８％）。 ３ 大肠镜检：共检出息肉患者６５１例,息肉１６７４枚,其中单发３４７例,…     

64例老年大肠息肉分析

６４例老年大肠息肉分析南京医科大学第一附属医院老年医学科（２１００２９）薛绮萍，仇晓华，杨美南随着人们生活的改善，寿命的延长，大肠息肉的发生率亦增高。我们对１９８９年１１日至１９９４年３月在我科作纤维结肠镜（简称结肠镜）检查的２３０例６０岁以上患者进...     

结肠镜下老年人大肠息肉临床特点分析

目前认为60％～80％大肠癌起源于大肠腺瘤,即“腺瘤-腺癌演变说”.随着年龄的增长,息肉的检出率呈增加趋势,且大肠息肉与肠癌关系密切.分析大肠息肉的临床特点、内镜下表现及病理类型,对于大肠息肉的诊治、大肠息肉癌变的早期防治具有重要的临床意义.收集我科近2年来结肠镜下发现的118例老年人大肠息肉的临床资料,并与146例中青年患者比较.现将结果报道如下.     

大肠息肉高频电摘除术并发症的防治策略

随着内镜技术的不断发展,结肠息肉内镜下治疗的适应征范围越来越扩大。但随之而来的内镜手术并发症也随之增多。减少并发症发生一直是内镜医护人员努力的目标。本院自1997年1月至2002年12月行大肠息肉内镜下高频电摘除术580人次,取得满意效果,但也遇到一些并发症。现结合临床实际就如何避免或减少手术并发症的发生作一探讨。     

内镜下高频电息肉摘除术治疗大肠息肉146例

将绒毛腺瘤作为癌来处理。关于腺瘤癌变的时间,一般平均１０年左右,亦有短至数月者,我们认为一旦发现息肉即应摘除。由于腺瘤性息肉的复发率达３９％,因此术后密切随访尤为重要。我们认为对腺瘤性息肉伴不典型增生者,应于术后３～６个月复查,以后可每隔１年复查１次,如无新的病变,可延长至每２～３年复查１次内镜下高频电息肉摘除术治疗大肠息肉146例@辛洪波$济南市槐荫区人民医院!250021@姜甦$济南市槐荫区人民医院!250021@陈忠$济南市槐荫区人民医院!250021     

1032例大肠息肉治疗探讨

近年来，由于结肠镜的广泛应用，各种医疗配套设备的不断完善，经结肠镜行内镜下息肉摘除术已成为治疗大肠息肉的首选方法。本院内镜中心自1995年7月至2004年7月对1032例大肠息肉采用内镜下息肉摘除术，取得了较好疗效，现总结报告如下。     

结直肠息肉癌变的内镜下表现、治疗及癌变因素分析

目的探讨结直肠息肉癌变的内镜下表现,分析癌变相关因素和治疗策略。方法回顾性分析经电子结肠镜检查或治疗的77例结直肠癌变息肉患者的临床、内镜及病理资料,探讨影响结直肠息肉癌变的相关因素及其内镜下治疗策略。结果77例癌变结直肠息肉中,9例伴发结肠癌。60例有临床症状,症状发生率为77．9％（60／77）。息肉癌变主要分布在乙状结肠,多发生于年龄超过60岁的老年患者,绒毛状腺瘤癌变率最高。行电子结肠镜电切法切除44例,其中完全切除38例。结论年龄〉60岁患者和乙状结肠息肉癌变发生率明显增高,选择性对属于原位癌或早期浸润癌的癌变息肉行电子结肠镜下切除是安全有效的。     

大肠良恶性息肉的临床特征及内镜、病理形态学特点

目的探讨大肠良恶性息肉的分布、大小、形态和病理特征以及息肉恶变过程中的相关因素。方法对电子结肠镜检出的大肠良恶性息肉患者的临床表现及内镜、病理资料进行分析。结果大肠息肉的检出率为１０．６６％,其中腺瘤性息肉占４７．１６％。主要的临床表现为便血。炎性息肉以≤１．０ｃｍ的为最多,腺瘤性息肉则大小不等,幼年性息肉以１．１～１．９ｃｍ的最多,同时伴肠癌者息肉以＜１．０ｃｍ为主。本组息肉０．６～１．０ｃｍ者恶变率３．５１％,１．１～１．９ｃｍ者恶变率为１２．９０％,≥２．０ｃｍ者恶变率２７．７８％,息肉恶变以山田Ⅱ型为主。结论腺瘤体积大,绒毛状结构者易恶变;大肠腺瘤性息肉常与大肠癌并存;大肠镜检查应尽量检查全大肠,不能满足于远端大肠病变的诊断;息肉不论大小应尽可能予以切除。     

28例伪膜性肠炎的内镜及临床特点分析

目的探讨伪膜性肠炎(PMC)的诱因、临床表现、结肠镜下特征、诊断及防治。方法对我院2005年5月-2012年5月收治的门诊和住院的共28例PMC患者进行回顾性分析。结果所有患者均出现腹泻,其中11例患者均在使用抗生素过程中出现腹泻;13例患者为老年多病长期服用多种药物致免疫力下降;4例应用糖皮质激素后出现腹痛、腹泻症状。结肠镜检查表现为各段结肠黏膜不同程度地出现充血、水肿及密集点状黄白色微隆起斑块,表面覆有伪膜,其中轻度9例、中度15例、重度4例。所有患者停用抗生素及激素类药物,口服甲硝唑或万古霉素后,均获得治愈或好转。结论伪膜性肠炎常发生在长期应用抗生素、激素及免疫力低下患者,结肠镜检查有助于诊断,早期治疗预后良好。     

内镜下微波治疗消化道息肉的实验及临床研究

目的 观察内镜下微波治疗消化道息肉的效果。 方法 进行了体外实验和临床研究。患有食管、胃或结肠息肉的120例患者,采用微波功率90 mA、时间6 s/次、依息肉大小决定点灼次数和调节天线插入组织深度的方法。 结果 凝除息肉134颗,其中特大息肉(4cm×3cm-5cm×4cm)5颗。131颗经1次治疗后息肉完全脱落(97.8％)。最早复查时间为治疗后第5d,息肉已脱落,仅遗留浅溃疡。5例特大息肉分别点灼16-30次后均1次性脱落。 结论 微波是治疗无蒂或亚蒂状息肉的安全、有效方法。在微波治疗中,不必强调使息肉出现白色凝固或达到汽化或碳化。使息肉变色、萎缩即可。微波为特大息肉的治疗开辟了一条新的途径。     

Prevalence of Proximal Neoplasms Among Asymptomatic Patients According to Distal Colorectal Findings

Colorectal cancer has been described in association with hyperplastic polyposis. Only half of proximal colon cancers are associated with distal adenomas. To compare the prevalence of proximal and advanced neoplasia between patients with distal hyperplastic polyps only; with distal adenomas with or without hyperplastic polyps; and with no distal polyps, we retrospectively analyzed data of 1,064 adults who underwent colonoscopy. Of these patients, 3% had neoplasia. Proximal neoplasia occurred in 0.8% of 945 patients with no distal polyps, compared to none of 19 with distal hyperplastic polyps (P > 0.05) and 6% with distal adenomas (P > 0.05). Proximal advanced neoplasia occurred in 0.6% patients with no distal polyps, compared with none with distal hyperplastic polyps (P > 0.05) and 6% with distal adenomas (P > 0.05). In conclusion, patients with distal hyperplastic polyps, unlike those with distal adenomas, do not exhibit an increased risk for proximal neoplasia or proximal advanced neoplasia compared to those with no distal polyps.     

Risk of proximal colorectal neoplasia among asymptomatic patients with distal hyperplastic polyps

PURPOSE: Many guidelines on colorectal cancer screening do not consider distal hyperplastic polyps to be a marker for proximal neoplasia. However, 11 of 17 published studies have shown an increased risk of proximal neoplasia in patients with distal hyperplastic polyps. Our goal is to assess the risk of proximal neoplasia in asymptomatic patients with distal hyperplastic polyps, compared to those with distal tubular adenomas or no distal polyps. METHODS: We assessed proximal (cecum, ascending, transverse colon and splenic flexure) and distal polyps in patients undergoing screening colonoscopy, classifying them into 3 groups: distal hyperplastic polyps only; distal adenomas with or without hyperplastic polyps; no distal polyps. The prevalence of proximal neoplasia and advanced neoplasia (polyps > or =1 cm, villous adenomas, or cancer) was compared among these groups. RESULTS: Of 2357 patients, 427 (18%) had neoplasia, including 103 (4%) with advanced neoplasia. Proximal neoplasia occurred in 175 (9%) of 1896 patients with no distal polyps, compared with 28 (12%) of 237 with distal hyperplastic polyps (P = 0.20) and 64 (29%) of 224 with distal adenomas (P <0.0001). Proximal advanced neoplasia occurred in 39 (2%) patients with no distal polyps, compared with 4 (2%) with distal hyperplastic polyps (P = 0.70) and 9 (4%) with distal adenomas (P = 0.13). CONCLUSIONS: Patients with distal hyperplastic polyps, unlike those with distal adenomas, do not exhibit an increased risk for proximal neoplasia or proximal advanced neoplasia compared to those with no distal polyps. The discovery of hyperplastic polyps on screening sigmoidoscopy should not prompt colonoscopy.     

Conventional colonoscopy and magnified chromoendoscopy for the endoscopic histological prediction of diminutive colorectal polyps： A single operator study

AIM: To accurately differentiate the adenomatous from the non-adenomatous polyps by colonoscopy. METHODS: All lesions detected by colonoscopy were first diagnosed using the conventional view followed by chromoendoscopy with magnification. The diagnosis at each step was recorded consecutively. All polyps were completely removed endoscopically for histological evaluation. The accuracy rate of each type of endoscopic diagnosis was evaluated, using histological findings as gold standard. RESULTS: A total of 240 lesions were identified, of which 158 (65.8%) were non-neoplastic and 82 (34.2%) were adenomatous. The overall diagnostic accuracy of conventional view, and chromoendoscopy with magnification was 76.3% (183/240) and 95.4% (229/240), respectively (P< 0.001) CONCLUSION: The combination of colonoscopy and magnified chromoendoscopy is the most reliable non-biopsy method for distinguishing the non-neoplastic from the neoplastic lesions.     

Interendoscopist variability in proximal colon polyp detection is twice higher for serrated polyps than adenomas

AIMTo assess the interendoscopist variability in the detection of colorectal polyps according to their location and histological type.METHODSThis study was a retrospective analysis of prospectively collected data from a regional colorectal cancer (CRC) screening program; 2979 complete colonoscopies from 18 endoscopists were included. Variability in performance between endoscopists for detection of at least one adenoma (A), one proximal adenoma (PA), one distal adenoma (DA), and one proximal serrated polyp (PSP) was assessed by using multilevel logistic regression models.RESULTSThe observed detection rates among the 18 endoscopists ranged from 24.6% to 47.6% (mean = 35.7%) for A, from 19.1% to 39.0% (mean = 29.4%) for DA, from 6.0% to 22.9% (mean = 12.4%) for PA, and from 1.3% to 19.3% (mean = 6.9%) for PSP. After adjusting for patient-level variables (sex, age), the interendoscopist detection rates variability achieved a significant level for A, PA, and PSP but not for DA (P = 0.03, P = 0.02, P = 0.02 and P = 0.08, respectively). This heterogeneity, as measured by the variance partition coefficient, was approximately threefold higher for PA (6.6%) compared with A (2.1%), and twofold higher for PSP (12.3%) compared with PA.CONCLUSIONThese results demonstrate significant interendoscopist variability for proximal polyp particularly for serrated polyps, but not for distal adenoma detection. These findings contribute to explain the decreased effectiveness of complete colonoscopies at preventing proximal CRCs and the need to carefully assess the proximal colon during scope procedure.     

Conventional endoscopic features are not sufficient to differentiate small,early colorectal cancer

AIM:To evaluate the depth of invasion of small,early colorectal cancers(ECCs)using conventional endoscopic features.METHODS:From January 2005 to September 2011,colonoscopy cohort showed that a total of 72 patients with small colorectal cancers with the size less than 20mm underwent colonoscopy at the Yonsei University College of Medicine,Seoul,South Korea.Among them,8 patients were excluded due to incomplete medical records.Finally,a total of 64 ECCs with submucosa(SM)invasion and size less than 20 mm were included.One hundred fifty-two adenomas with size less than 20 mm were included as controls.Nine endoscopic features,including seven morphological findings(i.e.,loss of lobulation,excavation,demarcated and depressed areas,stalk swelling,fullness,fold convergence,and bleeding ulcers),pit patterns,and non-lifting signs,were evalu-ated retrospectively.All endoscopic features were evaluated by two experienced endoscopists who have each performed over 1000 colonoscopies annually for more than five years without knowledge of the histology.RESULTS:Among the morphological findings,the size of deep submucosal cancers was bigger than that of superficial lesions(16.9 mm vs 12.3 mm,P<0.001).Also,demarcated depressed areas,stalk swelling,and fullness were more common in deep SM cancers than in superficial tumors(demarcated depressed areas:52.0%vs 15.7%,P<0.001;stalk swelling:100%vs4.2%,P<0.001;fullness:25.0%vs 0%,P=0.001).Among deep SM cancers,96%of polyps showed invasive pit patterns,whereas 19.4%of superficial tumors showed invasive pit patterns(P<0.001).A positive non-lifting sign was more common in deep SM cancers(85.0%vs 28.6%,P<0.001).Diagnostic accuracy of invasive morphology,invasive pit patterns,and nonlifting signs for deep SM cancers were 71%,82%,and75%,respectively.CONCLUSION:Conventional endoscopic findings were insufficient to discriminate small,deep SM cancers from superficial SM cancers by white light,standard colonoscopy.