溃疡性结肠炎相关结直肠癌临床特点及癌变相关蛋白的表达

目的 探讨溃疡性结肠炎(UC)相关结直肠癌的临床特点及其癌变的可能机制.方法 收集北京协和医院1984年至2008年6例UC相关性结直肠癌,分析其发病情况、临床表现、病理类型、治疗及预后特点,免疫组化检测组织标本中结肠腺瘤性息肉蛋白(APC蛋白)、β-连环蛋白、p53蛋白和Wnt1蛋白表达的情况.结果 UC的癌变率为1.1%(6/534),女性多见(5/6),平均病程14.3年.临床均呈现典型的UC表现,病变常累及全结肠(5/6),均无原发性硬化性胆管炎.其中直肠癌4例、降结肠癌2例,病理类型以腺癌为主,预后较差.APC蛋白、β-连环蛋白、p53蛋白和wnt1蛋白表达的阳性率分别为6/6、6/6、5/6和6/6.结论 临床对病变累及全结肠、病程长的UC患者,应注意防止结直肠癌的发生,其癌变过程可能有多途径参与.     

溃疡性结肠炎癌变和丁酸的预防作用

溃疡性结肠炎(UC)是一种病因不明,主要累及直肠、乙状结肠黏膜甚至全结肠和末端回肠黏膜的慢性非特异性炎症。UC患者发生结直肠癌的风险增加,但其癌变机制尚不清楚。近年来,体外研究和动物实验均证实丁酸对结直肠癌具有化学预防作用。本文就UC的癌变机制、丁酸对结直肠癌的预防作用及其与UC相关结直肠癌的关系作一综述。     

青年结肠腺癌患者肿瘤部位及其类型与生存状态分析

目的 探讨不同原发部位的青年结肠腺癌患者出院后健康状况及生存状态。方法 回顾性分析285例青年结肠腺癌患者的临床资料，随机选取同期的285例老年结肠腺癌患者临床资料进行对比，对其不同部位结肠腺癌患者及其出院后健康状况和生存状态进行分析。结果 青年结肠腺癌患者中，男154例，女131例，升结肠、横结肠、降结肠、乙状结肠发病率分别为25.3%、11.6%、18.9%、44.2%,主要为Ⅲ、Ⅳ期病例(32.0%、47.7%)和中、低分化病例(40.3%、37.9%),出院后51.2%患者能行为自理，其中横结肠腺癌患者发病率最低(11.6%),行为自理比率最高(42.4%),5年生存率最高(75.7%);乙状结肠腺癌发病率最高(44.2%),行为非自理比率较高(40.5%),5年生存率最低(69.0%)。结论 不同原发部位的结肠腺癌患者院外健康状况及生存状态存在差异，青年结肠腺癌患者以乙状结肠腺癌多见，横结肠腺癌发病率最低；出院后行为自理者以横结肠腺癌患者最多。     

老年人近段结肠癌发病率升高

有人认为在过去的20年中日本结肠癌发病率显著升高主要是由于饮食习惯的西方化。为了弄清结肠癌分布部位及其相关因素的特点,本文分析了1975年到1994年间的1205例结肠癌病例。 方法:回顾性整理Iizuka医院1975年到1994年间组织学诊断为结肠癌的1205例日本籍患者的资料,分析有关年龄、性别、肿瘤位置等的临床病理资料。肿瘤位置分成三组:近段结肠(盲肠、升结肠、结肠肝曲、横结肠)、远段结肠(结肠脾曲、降结肠、乙状结肠)、直肠。     

腹腔镜全结肠切除术4例报告

2002~2005年,本院共实施腹腔镜全结肠切除术4例。现报告如下。临床资料:4例患者均为女性。1例结肠多原发癌患者54岁,肠镜检查示升结肠近端、远端及横结肠近端3处癌灶,横结肠、降结肠、乙状结肠多发性息肉,且多处伴重度不典型增生。3例家族性腺瘤性息肉病(FAP)患者的年龄分别为2     

中国人结直肠腺癌雌激素受体β的表达

目的:确定ER β在中国人结直肠癌中的表达特点.方法:采用免疫组织化学方法对40例结直肠癌进行了ER β检测,10例结肠腺瘤以及10例正常结肠活检标本作为对照组也进行了ER β检测.结果:ER β在正常人结肠黏膜、结肠腺瘤以及结直肠癌组织中均有不同程度的表达,正常结肠黏膜(2/10)和结肠腺瘤组织(3/10)主要表现为上皮及腺体细胞核及核周胞质染色,而结直肠癌呈弥漫性胞质染色,其中约57.5%CRCs患者核染阳性率大于10%.ER β阳性和阴性组与肿瘤浸润深度、淋巴结转移以及生存率无明显相关.结论:结直肠癌组织中存在大量的ER β阳性细胞;部分正常结肠黏膜也存在ER β的表达;ER β在正常人结肠黏膜、结肠腺瘤细胞以核及核周胞质染色为主,而结直肠癌组织以上弥漫性胞质染色为主.     

大肠息肉的内镜特点及病理分析

对142例大肠息肉的临床、内镜及病理特点进行了回顾性分析。现报告如下。1临床资料收集该院2006年5月~2007年5月结肠镜检查患者,镜下发现息肉142例,共198枚。其中男85例,女57例,年龄12~74岁,平均47岁。临床表现为便血(占80.2%)、黏液便、腹痛、腹泻等,部分患者同时存在多种症状。息肉的分布定位为4个主要的解剖部位:①右半结肠:盲肠和升结肠;②横结肠:肝曲、横结肠、脾曲;③左半结肠;降结肠、乙状结肠;④直肠:直肠和肛管。多发性:病变累及上述2个或以上部位。2结果2.1内镜下表现病变部位:右半结肠20枚(10.10%)、横结肠15枚(7.57%)、左半结肠…     

82例结直肠癌根治术后结肠镜检查结果分析

2007年6月~2010年6月,我们对82例结直肠癌术后患者进行了结肠镜检查。现将检查结果如下分析。临床资料：82例结直肠癌术后患者,男50例、女32例,年龄35~70岁。直肠癌43例,乙状结肠癌12例,降结肠癌6例,横结肠癌17例,升结肠2例,回盲部癌2例。术后2 a     

放大色素结肠镜观察FAS、Ki-67在直肠异常隐窝病灶中的表达

目的:观察FAS、Ki-67在结肠腺瘤、异常隐窝病灶(aberrant crypt foci,ACF)中的表达,探讨脂肪酸合成酶(fatty acid synthase,FAS)、增殖细胞核抗原(Ki-67)的异常表达在结直肠癌癌前病变形成中的意义.方法:对34例结肠镜确诊为腺瘤性息肉患者,常规内镜检查结束时,用0.2%的亚甲蓝溶液染色直肠黏膜,然后使用放大结肠镜观察直肠寻找ACF.对结肠腺瘤性息肉、ACF及正常黏膜活检标本进行免疫组织化学分析其FAS和Ki-67的表达.结果:34例结肠腺瘤性息肉患者,其中31例直肠发现ACF,共发现并活检ACF166处(其中伴异型增生14处,不伴异型增生152处).FAS、K i-67在结肠腺瘤、A C F中呈异常高表达(P<0.01).伴异型增生ACF中FAS、Ki-67表达较不伴异型增生ACF无明显上调.结论:FAS、Ki-67在结直肠癌的癌前病变(腺瘤、ACF)呈异常高表达.结直肠癌的癌前病变存在细胞能量代谢异常及异常增殖,在ACF阶段就已经异常增殖明显,抑制FAS有望成为结直肠癌预防、治疗的靶点.     

结肠,直肠癌术后复发再手术探讨

结肠、直肠癌术后复发再手术探讨山东省立医院（２５００２１）阮永威谭辉侯连泽李乐平１９８５～１９９４年，我院收治３０例结肠、直肠癌术后复发而需行再次手术的患者，年龄２８～７２岁，平均４９．５岁。肿瘤原发灶位于升结肠５例，横结肠２例，降结肠６例，乙状结肠...     

Rectosigmoid findings are not associated with proximal colon cancer： Analysis of 6 196 consecutive cases undergoing total colonoscopy

AIM: To review the risk of proximal colon cancer in patients undergoing colonoscopy. METHODS: We estimated the risk of advanced proximal adenomas and cancers in 6 196 consecutive patients that underwent colonoscopy (mean age 60 years, 65% males, without prior history of colorectal examination). Neoplasms were classified as diminutive adenoma (5 mm or less), small adenoma (6-9 mm), advanced adenoma (10 mm or more, with villous component or high-grade dysplasia) and cancer (invasive adenocarcinoma). The sites of neoplasms were defined as rectosigmoid (rectum and sigmoid colon) and proximal colon (from cecum to descending colon). RESULTS: The trend of the prevalence of advanced proximal adenoma was to increase with severe rectosigmoid findings, while the prevalence of proximal colon cancer did not increase with severe rectosigmoid findings. Among the 157 patients with proximal colon cancer, 74% had no neoplasm in the rectosigmoid colon. Multivariate logistic-regression analysis revealed that age was the main predictor of proximal colon cancer and existence of rectosigmoid adenoma was not a predictor of proximal colon cancer. CONCLUSION: Sigmoidoscopy is inadequate for colorectal cancer screening, especially in older populations.     

结直肠锯齿状腺瘤与传统腺瘤的内镜表现和病理学特征比较

目的通过分析结直肠锯齿状腺瘤（SA）和传统腺瘤的内镜和病理学特征的差异,加强对SA的认识。方法比较2008年6月至2013年10月天津医科大学总医院消化内镜中心检出的80例SA和160例传统腺瘤的一般情况、内镜表现和病理学特征。结果SA患者平均年龄比传统腺瘤患者小[（57．5±13．8）岁和（62．3±12．2）岁,P=0．0038],而男女性别构成,两组间差异无统计学意义（P〉0．05）。在内镜特征方面,SA主要发生于直乙结肠（60％）,传统腺瘤好发部位为直乙结肠（45％）、升结肠（20％）和降结肠（19％）,两组病变部位差异有统计学意义（P〈0．05）;在内镜形态分型（隆起型及表面型）和腺瘤大小方面比较,两组组间差异亦无统计学意义（P〉0．05）。在病理学方面,SA具有独特的锯齿状结构,传统腺瘤为管状、管状绒毛状和绒毛状结构。传统腺瘤的低级别瘤变率高于SA（P〈0．05）,但sA仍有约1．9％的局部恶变率。结论sA与传统腺瘤在年龄、发生部位和病理学特征方面存在差异,是一种独特的腺瘤类型,有一定恶变潜能,应引起临床和内镜医师的高度重视。     

Demography and clinical course of ulcerative colitis in a multiracial Asian population: A nationwide study from Malaysia

OBJECTIVE: To establish the clinical course of ulcerative colitis (UC) in the Malaysian population, comparing the three major ethnic groups: Malay, Chinese and Indian. METHODS: Patients who were diagnosed with UC from seven major medical referral centers in Malaysia were recruited. Their baseline characteristics, and the extent of the disease, its clinical course and complications were recorded. RESULTS: A total of 118 patients was included. The extent of disease was as follows: proctitis alone in 22 (18.6%), sigmoid colon in 23 (19.5%), descending colon in 16 (13.6%), transverse colon in 11 (9.3%), ascending colon and pancolitis 46 (39%). Most patients had chronic intermittent disease. Extra‐intestinal complications were seen in 27 (22.9%) patients and fulminant colitis was seen in four (3.4%). None developed colorectal cancer. The overall cumulative colectomy rates at 1, 5 and 10 years were 3.4% (CI: 0.9–8.5), 5.9% (CI: 1.9–13.2) and 15.6% (CI: 6.5–29.4), respectively. There was a higher prevalence of extra‐intestinal manifestations and a trend towards more extensive disease among Indian patients. However, no significant differences were seen in the age of onset, the severity of disease (fulminant colitis, refractory disease) and the colectomy rate. CONCLUSION: As in developed countries, most of our patients have a remitting and relapsing pattern of disease but the clinical course appears to be milder, with lower rates of colectomies. There are differences in clinical presentation among the three major ethnic groups, with Indians having a higher prevalence of extra‐intestinal manifestations and a trend towards more extensive disease.     

Changes in site distribution of colorectal carcinoma in Connecticut, 1940–1973

The proportion of colorectal cancer occurring above the rectosigmoid junction has been increasing over time. The 40,771 cases of colorectal carcinoma reported to the Connecticut Tumor Registry from 1940 through 1973 were analyzed to determine the incidence in the ascending colon, the transverse, descending, and sigmoid colon, and the rectum. The numbers of cases, the proportion, and incidence rates of cancer in the ascending colon and sigmoid have increased over the 34 years. The increases were greatest among people over 65 years old. Only about half of colorectal cancer can now be identified with the rigid sigmoidoscope. Other tests must be used for early diagnosis of the increased numbers of cancers in the upper parts of the colon.     

Risk of Advanced Proximal Adenoma and Cancer According to Rectosigmoid Findings in the Korean Population

Colorectal cancer is one of the leading causes of cancer death in the United States and Europe. Recently, the incidence of colorectal cancer has been increasing remarkably in Korea. To reduce the high incidence, screening of colorectal cancer in asymptomatic individuals has been advocated. Sigmoidoscopy is simpler, faster, and better tolerable than total colonoscopy, but the scope cannot reach the proximal colon segment and, therefore, may miss proximal colon cancer. In the present study, we intended to investigate the prevalence of proximal adenoma and cancer according to the findings in rectosigmoid colon and to find their risk factors. Data were collected retrospectively from 1541 consecutive patients who underwent total colonoscopy at the Department of Gastroenterology, Hanyang University, between October 2003 and December 2004. Neoplasms were classified as diminutive adenoma (≤5 mm), small adenoma (6–9 mm), advanced adenoma (≥10 mm, with villous component or high-grade dysplasia), and cancer. The sites of neoplasms were defined as rectosigmoid (rectum and sigmoid colon) and proximal (from cecum to descending colon) colon. The prevalence of advanced proximal adenoma was associated with severe rectosigmoid findings. On the other hand, the prevalence of proximal colon cancer did not show such a tendency. Among the 131 patients with proximal advanced adenoma, 66% had no neoplasm in the rectosigmoid colon. Moreover, among the 27 patients with proximal cancer, 52% had no neoplasm in the rectosigmoid colon. Multivariate logistic regression analysis revealed that age, gender, and advanced rectosigmoid adenoma were the risk factors of advanced proximal adenoma, but nothing was associated with the risk for proximal colon cancer. Advanced rectosigmoid adenoma may be the predictor of advanced proximal adenoma, especially in old males. However, nothing is related to the risk for proximal colon cancer. Therefore, colonoscopy may be more adequate for colorectal cancer screening than sigmoidoscopy in the Korean population.     

溃疡性结肠炎相关结直肠癌的基因组和表观遗传不稳定性

溃疡性结肠炎相关结直肠癌（UcCRC）是溃疡性结肠炎（UC）最严重的并发症。近年来,由遗传易感性与环境因素共同作用引起的、结直肠黏膜慢性炎症背景下的遗传学改变在UcCRC发生、发展中的作用备受关注。本文就UcCRC中的常见基因组和表观遗传不稳定性,包括染色体不稳定性（CIN）、微卫星不稳定性（MSI）、CpG岛甲基化表型（CIMP）作一综述。     

大肠侧向发育型肿瘤内镜下的诊断与治疗

目的探讨大肠侧向发育型肿瘤（LST）临床病理特征及内镜下黏膜切除术的有效性、安全性。方法经普通内镜检查发现LST 119例,染色后观察病灶大小及部位并进行形态分型,再结合放大内镜确定腺管开口类型。有治疗适应证者行内镜下黏膜切除术,切除病灶黏膜送病理检查。结果 28个月中共发现119例LST 124个病变。内镜下分型：颗粒均一型44个,结节混合型48个,平坦隆起型23个,假凹陷型9个。病变直径：10～20 mm 65个,21～30 mm 23个,31 mm以上36个,最大病变110 mm×100 mm。病变部位：直肠50个,乙状结肠25个,降结肠11个,横结肠10个,升结肠＋盲肠28个。黏膜腺管开口类型：Ⅲ型30个,其中17个为管状绒毛状腺瘤,12个为管状腺瘤;Ⅳ型56个,其中30个为绒毛状腺瘤,4个为黏膜内癌;Ⅴ型5个,其中2个为黏膜内癌,2个累及黏膜下层下1/3以下;Ⅱ型7个,其中5个为炎性增生性息肉,2个为锯齿状腺瘤（腺瘤性增生性息肉）：其余为ⅢL＋V型,其中23个为管状绒毛状腺瘤。符合适应证95例98个病变择期进行内镜下黏膜切除治疗,发生出血11例,均在操作过程中,无肠穿孔发生。结论大肠LST内镜形态具有一定特殊性,内镜下黏膜切除术是治疗在大肠的有效而安全的方法,可达到根治目的 。     

内镜下黏膜染色联合黏膜切除对大肠侧向发育肿瘤的诊断治疗

目的 探讨普通电子肠镜下靛胭脂黏膜染色联合黏膜切除对大肠侧向发育型肿瘤及早期大肠癌的临床诊治价值。方法 对3860例肠镜检查中发现的肠腔黏膜隆起、红斑、表面粗糙不平、血管纹理消失、肠黏膜无名沟中断等可疑黏膜病灶，行镜下喷洒0．4％靛胭脂黏膜染色，对染色发现的大肠侧向发育型肿瘤，观察病灶大小并进行形态分型，病灶黏膜可随充吸气变形者及黏膜下注射液体呈抬举征阳性者行内镜黏膜切除（EMR）21例、内镜下分片黏膜切除术（EPMR）11例、未能行黏膜切除者行活检6例，切除病灶黏膜送病理检查。结果 发现LST病灶38侧，检出率为0．98％。其中．颗粒均一型18个（46．6％）、结节混合型10个（25．9％）、平坦隆起型7个（18．1％）．假凹陷型3个（7．8％）。病变分布：直肠15个（39．5％），乙状结肠8个（21．0％），降结肠5个（13．2％），横结肠4个（10．5％），升结肠3个（7．9％）．回盲部3个（7．9％）。病理检查：38例LST病灶中早期癌5例，检出率为13．2％，进展期大肠癌2例（5．2％）．良性腺瘤31（81．6％）。结论 普通电子肠镜下对大肠黏膜可疑病灶靛胭脂染色能够有效发现大肠LST病灶，联合镜下黏膜切除对早期大肠癌诊断和防治具有较高的临床价值。