儿童结直肠幼年性息肉及其研究进展

结直肠幼年性息肉是儿童最常见的肠息肉类型,以间歇性无痛性便血为主要临床表现,诊断首选结肠镜检查,一旦发现立即切除.目前该病变的病因及发病机制仍不清楚,一般认为该病变为良性错构瘤,组织学上以黏膜固有层间质的增生、炎性细胞浸润及腺体的囊性扩张为特点.该文对儿童结直肠幼年性息肉的临床表现、组织学特点、生物学特性、诊疗方法、病因及分子机制研究进展进行综述.     

儿童结直肠息肉的临床特征

结直肠息肉是儿童常见病,是儿童无痛性便血的常见病因。随着儿童结肠镜检查技术的推广,越来越多的结直肠息肉患儿得到了诊断和治疗。结直肠息肉多在幼儿期、学龄前期出现症状,通过结肠镜检查,能够确认息肉的部位、大小、数量,能够进行病理检查确定其性质。儿童结直肠息肉有炎性息肉、错构瘤性息肉、腺瘤性息肉等多种类型。儿科医生需要提高认识,对有症状或有相关家族史的患儿积极进行结肠镜检查。     

儿童结直肠息肉的内镜治疗

儿童结直肠息肉是临床中无痛性便血、腹痛和肛门肿物突出最主要的就诊原因。根据临床表现和组织学结构上的差异分类,早期诊治不影响生长发育及营养吸收。发现息肉应行内镜下息肉切除,若幼年性息肉合并腺瘤或为腺瘤性息肉,需定期行结肠镜复查。目前内镜下高频电凝电切术联合金属钛夹是治疗儿童结直肠息肉的主要方法之一。     

儿童结直肠息肉内镜下诊疗

结直肠息肉是儿童消化道常见的疾病之一,消化内镜对其的诊治价值已得到广泛认可。随着儿童内镜设备及技术的不断发展,儿童结直肠息肉的内镜诊断和治疗变得更加安全、简便、有效。文章主要介绍儿童结直肠息肉内镜诊断和治疗的进展。     

小探头超声在儿童结直肠息肉诊治中的应用

小探头超声（miniprobe ultrasonography,MPS）在结直肠息肉病变诊治中有重要临床应用价值。结直肠息肉内镜切除术前行MPS内镜检查可有效诊断儿童结直肠息肉,并准确了解结直肠息肉的来源,为其治疗方式提供重要依据,减少并发症的发生。该文对结直肠MPS检查的特点、方法、临床应用等方面进行综述。     

儿童结直肠息肉 670 例临床分析

目的探讨儿童结直肠息肉的临床特点以及内镜下黏膜剥离切除术(EMR)的治疗价值。方法回顾分析2012年至2017年收治的确诊为结直肠息肉后立即行EMR的患儿临床资料。结果 670例患儿中,男423例、女237例,平均确诊年龄(4.50±2.69)岁,高发于3～6岁(43.4%)。临床表现以便血(90.3%)为主。息肉以单发(92.5%)为主,多发于直肠(49.0%)及乙状结肠(35.2%);直径多2 cm(78.9%)。息肉≥2 cm者需钛夹夹闭创面,而息肉直径2 cm者钛夹对术后出血无影响。术后并发出血主要发生在术后第1天。术后病理回报提示以幼年性息肉为主。结论结直肠息肉高发于学龄前男童,以幼年性息肉为主;EMR辅以金属钛夹可减少术后出血。     

肠道菌群与儿童结直肠息肉研究进展

结直肠息肉是儿童消化道出血的常见病因,以幼年性息肉最常见,绝大部分为良性病变,但也存在恶变可能。肠道微生物群与结直肠息肉密切相关,遗传因素在结直肠息肉的发生中发挥重要作用,但多种环境因素如高脂饮食、肥胖、幽门螺杆菌感染等可通过改变肠道微生物群而影响其发病。结直肠息肉患儿存在肠道微生态失衡,且不同类型、不同位置的息肉患儿其肠道微生态结构也存在差异,通过饮食干预、补充益生菌、益生元、合生元及某些药物调节肠道微生态平衡,可能成为防治儿童结直肠息肉的新策略。     

增殖细胞核抗原在幼年性息肉病不典型增生中表达及意义

目的 探讨增殖细胞核抗原与幼年性息肉病不典型增生改变的关系。方法 应用免疫组织化学方法检测了5例幼年性，息肉病的24枚不典型增生息肉和11枚无不典型增生启，肉标本、32例单发结直肠幼年性息肉、5例正常小儿结肠粘膜和10例大肠癌标本的增殖细胞核抗原(proliferating cell nuclear antigen，PCNA)的表达：结果 PCNA标记指数(PCNA labelling index，PCNA LI)均值在幼年性息肉病不典型增生组显著高于无不典型增生组。结论 PCNA与幼年性息肉病不典型增生密切相关，推测这种高增殖活性是幼年性息肉病不典型增生发生发展的病理基础。     

幼年性息肉和幼年性息肉病回顾性病理分析

目的 了解我国幼年性息肉病（JPS）不典型增生改变的存在，比较单发结、直肠幼年性息肉（JP）和JPS的不同病理特点。方法 32例单发结、直肠JP标本和5例JPS（共35枚息肉）标本经常规切片，HE染色后进行病理检查，观察不典型增生改变情况并进行分级。结果 32枚单发结、直肠JP未见不典型增生改变。5例JPS的35枚息肉中4例24枚息肉（68.6%)局部有不典型增生改变，其中轻度16枚，中工7枚，重度1枚。结论 JPS和单发结、直肠JP病理改变不完全相同。前才由于息肉是多发的，个别息肉局部可出现不典型增生改变，因而多认为是癌前病变，后者多为良性病变。     

儿童结直肠息肉内镜下切除护理配合

儿童结直肠息肉的治疗主要包括内镜微创治疗和外科手术治疗。内镜微创治疗是目前首选的治疗方式。诊疗全流程的有效护理配合可明显提高内镜下结直肠息肉切除的治疗效果,并减少术后并发症的发生。该文就儿童结直肠息肉内镜微创治疗的术前、术中及术后护理随访等内容展开综述。     

Management of colorectal polyps in children

Forty-two patients each with a colorectal polyp have been treated in our hospital over the past 10 years. In twenty-two cases the polyps were noted in the rectum, nine in the sigmoid colon, seven in the descending colon and four in the transverse colon. Each patient had only one polyp. Hematochezia was the main symptom in 29 patients, prolapse of the polyp from the anus in 10, abdominal pain due to intussusception in two and no symptoms were observed in one. Auto-amputation of the polyp was considered to have occurred in five patients. Twelve rectal polyps were resected from a transanal operation, and another 25 polyps were removed endoscopically with electric cautery. We have had no experience of endoscopic complications such as bleeding or perforation. A histological examination revealed an adenoma in one patient. Other polyps were non-neoplastic and were classified as juvenile, inflammatory and hyperplastic in 30, two and four patients, respectively. There have been no recurrences of polyps to date.     

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??Hematochezia??abdominal pain and anal tumor are the main clinical complaints of colonic polyps in children. Classification is made according to clinical manifestation and histological structure difference??and growth and development and nutrient absorption are not affected by early diagnosis and treatment. Polyps should be removed by endoscopic polypectomy??if juvenile polyps are combined with adenoma or adenomatous polyp??regular colonoscopy should be done. At present??endoscopic high-frequency electrocoagulation combined with metal titanium clip is one of the main methods for the treatment of colorectal polyps in children.     

Juvenile colorectal polyps in children: experience in Pakistan

Juvenile colorectal polyps are the most common cause of pediatric hematochezia and contribute to significant morbidity if not treated early. This report describes an experience with juvenile colorectal polyps in children (14 years) from Pakistan. In a 3-year period, 154 polyps were documented in 129 children. The mean age at presentation was 5.2 years, with a male predominance. Most children presented with painless rectal bleeding (±13 months) associated with other symptoms, such as protrusion of a mass through the anus, diarrhea, and recurrent abdominal pain. Anemia was observed in 54 children, of whom 14 (26%) required blood transfusion before intervention. Diagnosis was made by digital rectal examination, proctosigmoidoscopy, and barium enema. The average distance of a colorectal polyp was 4 cm from the anal verge. In 108 (84%) children the polyps were solitary, whereas 21 patients had more than one polyp (maximum three) at different locations in the rectosigmoid area. All polyps were successfully removed by proctosigmoidoscopy. Histological examination revealed dysplastic changes in one case, while the rest were inflammatory. Recurrence occurred in seven children within 1 year of initial removal. Juvenile colorectal polyps contribute to a substantial morbidity in children and do carry a minimal risk of developing dysplastic changes, and therefore should be removed early.     

The mucosa beyond the polyps in juvenile polyposis

Little is known of early histologic changes in the mucosa of the colon aside from the polyps in Juvenile Polyposis. Provided with a surgical specimen of a total colectomy of a 6-year-old boy with this condition, this report describes those changes. The mucosa depicted a peculiar serrated profile of the uppermost part of the crypts due to elongation of them, dilated openings, and scant stroma. Also present were frequent aberrant crypts. Early juvenile polyps presented associated with lympho-glandular sites as distorted and microcystically dilated crypts containing granular and filamentous mucoid material. The findings possibly represent the abnormal cytologic potential of this genetic condition.     

Colorectal neoplasia in juvenile polyposis or juvenile polyps.

Juvenile (retention) polyps are usually solitary lesions in the colorectum but may be multiple in juvenile polyposis. The association between juvenile polyps and colorectal neoplasia is controversial. We present three patients with juvenile polyposis who had colorectal adenomas or adenomatous epithelium in juvenile polyps at ages 3, 4, and 7 years. In a retrospective study of 57 additional patients with one or more juvenile polyps, 10 patients (18%) had colorectal neoplasia including three with adenocarcinoma, two with tubular adenoma, and six with adenomatous epithelium in a juvenile polyp (one had both adenomatous epithelium and an adenocarcinoma). Nine of these 10 patients had juvenile polyposis defined by the presence of at least three juvenile polyps; and eight of the nine had a family history of juvenile polyps. Colorectal neoplasia occurred at young age (mean (SEM) 37 (5) years). Our findings suggest that patients with juvenile polyps who have three or more juvenile polyps or a family history of juvenile polyps should undergo surveillance for colorectal neoplasia.     

Prevalence of polyomavirus viruria (JC virus/BK virus) in children following liver transplantation

Brinkert F, Briem-Richter A, Ilchmann C, Kemper MJ, Ganschow R. Prevalence of polyomavirus viruria (JC virus/BK virus) in children following liver transplantation.
Pediatr Transplantation 2010: 14: 105–108. © 2009 John Wiley & Sons A/S.
Abstract:  BKV infection is a potential cause of renal dysfunction in non-renal organ transplant recipients. JCV is the causative agent of PML. Furthermore, polyomaviruses are tumor inducing viruses and molecular data suggest an association with malignancies among solid organ transplant patients. So far, there are no studies analyzing polyomavirus viruria following Ltx in children. We performed a prospective prevalence study at a mean of 2187 (range 20–5671) days after transplantation in 100 consecutive children admitted for the routine follow-up examination post-Ltx. The urine was screened for BKV and JCV DNA by using PCR in each case. A plasma analysis by PCR was also done if more than 100 000 DNA copies/mL urine were detected. BKV or JCV viruria was found in 19% (n = 19) of our patients. All patients were free of clinical signs of viral infection, PML, or nephropathy. GFR was normal in 97% of patients and we found no statistical difference of kidney function between patients with and without BKV/JCV viruria. The extent of immunosuppressive therapy had no influence on the polyomavirus viruria. Overall, we found a higher prevalence of polyomavirus viruria in our pediatric liver transplant recipients than reported in adult patients.