进展期结直肠腺瘤及高危腺瘤的危险因素分析

目的 探讨进展期结直肠腺瘤(ACA)及高危腺瘤的危险因素.方法 纳入2014年1月至2019年12月四川大学华西医院日间手术中心经内镜下治疗的结直肠腺瘤患者4573例(10653枚腺瘤),根据腺瘤直径大小、是否有绒毛结构形成或伴高级别上皮内瘤变,分为进展期腺瘤组(1205例患者,1619枚腺瘤)、非进展期腺瘤组(336...     

大肠癌精筛中内镜黏膜切除术对结直肠进展期腺瘤的诊治价值

目的探讨内镜黏膜切除术(EMR)在大肠癌精筛中诊治结直肠进展期腺瘤的临床价值。方法收集2016-01～2017-05广州市中西医结合医院结肠镜活检诊断为结直肠广基或亚蒂进展期腺瘤52例,行EMR切除病灶,并行病理学检查明确诊断,随访观察治疗效果和安全性。结果 47例病变予EMR切除,5例予内镜黏膜分片切除术(EPMR)切除,术中出血5例,均20 ml,术后无迟发型出血及穿孔发生。所有病变一次性整块切除率为90. 4%(47/52),组织治愈性切除率为88. 5%(46/52);术后病理提示绒毛状腺瘤或管状绒毛状腺瘤伴低级别上皮内瘤变(LGD) 38例(73. 1%),绒毛状腺瘤或管状绒毛状腺瘤伴高级别上皮内瘤变(HGD) 12例(23. 1%),另有2例(3. 8%)黏膜下癌转外科手术治疗,但术后病变肠段未发现肿瘤组织残留和淋巴结转移。50例患者术后随访3～15月(中位随访9个月)未见复发。结论 EMR诊治进展期腺瘤安全有效,在大肠癌精确筛查中能发挥关键的诊治价值。     

青年人群结直肠腺瘤患者发病的危险因素及临床特征分析

目的 探讨青年人群结直肠腺瘤患者发病的危险因素及临床特征。方法 回顾性纳入结直肠腺瘤患者1 149例,按照年龄范围将其分为青年组(349例,18～40岁)、中年组(400例,41～60岁)及老年组(400例,61～80岁),记录其腺瘤直径、数量、分布部位及病理类型并进行组内比较。根据问卷调查完成程度,从青年组349例患者中选取资料完整的患者233例作为青年腺瘤组,同时随机纳入同期结肠镜检查正常的青年健康体检者238例作为对照A组。再根据结直肠腺瘤分期,将青年腺瘤组中58例确诊为进展期腺瘤的患者作为青年进展期腺瘤组,从对照A组中随机选取116例受试者作为对照B组。采用问卷调查形式收集其临床资料并分组进行单因素分析。采用多因素logistic回归分析评估青年人群结直肠腺瘤及进展期腺瘤患者发病的危险因素。结果青年组腺瘤直径为6～9 mm患者比例均高于中年组和老年组,直径≥10 mm患者比例均低于中年组和老年组,直径≤5 mm患者比例高于中年组、低于老年组(P<0.05)。青年组、中年组与老年组单发腺瘤患者比例依次降低,多发腺瘤患者比例依次升高(P<0.05)。青年组左半结肠及直肠...     

结直肠腺瘤内镜下摘除后再发的危险因素分析

目的 评估内镜下摘除后结直肠腺瘤(CRA)再发的危险因素,为内镜治疗后监控策略的选择提供更多依据.方法 选择2017年1月至2018年12月成都市第六人民医院接受内镜下CRA摘除治疗患者220例,回顾性分析CRA摘除后(12(1)月内CRA复发情况及影响因素.结果 220例患者CRA摘除后12个月,内镜复查检出CRA ...     

IFOBT与肿瘤标志物、炎症指标联合检测对结直肠进展期腺瘤发生的预测价值

背景目前临床缺乏对结直肠癌前病变有效的无创筛查手段,识别高危人群和多指标联合检测已成为癌及癌前病变筛查的趋势.多种炎症指标已广泛用于各种肿瘤的诊断及预后,而对癌前病变诊断价值的研究较少.目的探讨粪便免疫潜血实验(immunochemical fecal occult blood testing,IFOBT),肿瘤标志物(CEA、CA199),炎症指标包括中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)、血小板/淋巴细胞比值(platelet/lymphocyte ratio,PLR)及一般临床特征对结直肠进展期腺瘤息肉发生的预测价值.方法回顾性分析我院2014-2018年行电子结肠镜检查并经病理学证实的295例结直肠进展期腺瘤病例作为观察组,选择同期448例非进展期腺瘤病例作为对照组,收集患者的一般临床资料包括基本特征(性别、年龄)、生活习惯(吸烟史、饮酒史)、既往史(高血压史、冠心病史、糖尿病史),手术史(胆囊或阑尾切除史);实验室检查(NLR、PLR、CEA、CA199、IFOBT);进行单因素差异分析,将有意义的结果纳入二元logistic回归分析,绘制ROC曲线,评估相关指标对结直肠进展期腺瘤发生的预测价值.结果Logistic回归分析显示:年龄(OR=1.047,95%CI:1.028-1.066,P=0.000)、吸烟(OR=1.880,95%CI:1.250-2.826,P=0.002)、糖尿病(OR=2.073,95CI%:1.216-3.535,P=0.007)、既往胆囊切除(OR=9.206,95CI%:2.904-29.181,P=0.000)、IFOBT(OR=7.681,95%CI:4.585-12.869,P=0.000)、CA199(OR=1.039,95%CI:1.018-1.059,P=0.000)、NLR(OR=1.706,95%CI:1.388-2.097,P=0.000)与进展期腺瘤的发生独立相关.对于预测进展期腺瘤的发生,IFOBT的灵敏度为34.6%,特异度为94.2%,AUC为0.644,95%CI:0.602-0.686,CA199的最佳截断点为7.87 U/mL,灵敏度为53.9%,特异度为66.1%,AUC为0.639,95%CI:0.598-0.679,NLR的最佳截断点为2.04,灵敏度为50.2%.特异度为71.8%,AUC为0.645,95%CI:0.605-0.685,当三者联合检测时其灵敏度为52.9%,特异度为82.8%,AUC 95%CI为0.752(0.716-0.788),进展期腺瘤亚组分析中,IFOBT(-)和IFOBT(+)亚组之间的腺瘤位置(P=0.048)、腺瘤直径(P=0.000)、分化级别(P=0.000)差异有统计学意义,低NLR(<2.04)和高NLR(≥2.04)亚组之间的性别(P=0.004)、腺瘤直径(P=0.028)、分化级别(P=0.000)差异有统计学意义.结论高龄、吸烟、糖尿病、既往胆囊切除人群更易发生结直肠进展期腺瘤,临床需对此类人群提高重视,IFOBT、NLR、CA199对进展期腺瘤的发生具有诊断意义,三者联合检测时其诊断效能最佳.     

结直肠腺瘤发生危险因素的病例对照

正结直肠癌是消化道常见的恶性肿瘤,发病率呈逐年上升的趋势。全国12个县市资料显示,结直肠癌死亡率已居第4～5位,与20世纪70年代相比,90年代城市发病率上升了31.95%,农村上升了8.51%。根据腺瘤-腺癌顺变假说,超过95%的结直肠癌起源于结直肠腺瘤,因此寻找与结直肠腺瘤相关的危险因素对预防结直肠癌发生有重要意义。本研究采用病例-对照研究分析结直肠腺瘤发生的危险因素。     

结肠镜检查中大肠腺瘤的漏诊率及漏诊相关危险因素

目的 明确结肠镜检查中大肠腺瘤的漏诊率及漏诊腺瘤特征,探讨腺瘤漏诊的相关危险因素.方法 患者在初次结肠镜检查发现并切除腺瘤后120 d内进行结肠镜复查,分析2次结肠镜检查结果.记录2次结肠镜检查所见腺瘤的特征（包括大小、部位、形态、数目及病理）、患者临床特征（包括年龄、性别、结肠镜检查原因、腹部及盆腔手术史、大肠憩室病史及是否行无痛结肠镜检查）及不同的内镜操作医师.分析不同类型腺瘤在结肠镜检查中的漏诊率以及腺瘤特征、患者临床特征和内镜医师的操作水平对腺瘤漏诊的影响.结果 809例患者中271例发生腺瘤漏诊,2次结肠镜检查共检出腺瘤2134颗,漏诊腺瘤425颗,腺瘤总漏诊率为20%（425/2134）;平均患者腺瘤漏诊率为33%（271/809）.腺瘤体积大者,漏诊率低（P〈0.01）;乙状结肠、肝曲、盲肠和升结肠部位的腺瘤以及平坦型腺瘤容易漏诊（P〈0.05）;患者腺瘤数越多在结肠镜检查中腺瘤漏诊率越高（P〈0.01）;初级内镜医师与有经验内镜医师相比,其漏诊率明显增加（P〈0.01）.结论 结肠镜检查中存在部分腺瘤漏诊,腺瘤漏诊与腺瘤大小、形态、部位、数目以及结肠镜检查操作医师密切相关.     

结直肠腺瘤切除术后复发息肉的特点分析

目的 研究结直肠腺瘤(colorectal adenoma,CRA)切除术后复发息肉的特点.方法 收集2005年5月-2012年5月于首都医科大学附属北京朝阳医院消化内科完成结肠镜下息肉切除术、病理组织学确诊为CRA,术后行肠镜复查,并发现复发息肉的患者103例.统计分析初发息肉的大小、数目、病理分型、发生部位、肠镜间隔时间与复发息肉的大小、数目、病理分型、发生部位之间的关系.结果 93％的患者复发息肉大小都在1 cm以内;复发息肉在左半结肠占65％,在右半结肠占12％,在全结肠占22％;初检CRA大小、数目、病理分级与复发息肉的大小、数目、病理分级,经统计分析均无关联,初检发生部位与复发息肉的发生部位有相关性(P＜0.05).结论 复发息肉通常是多发、较小、低危的,虽然大部分在第1年已经出现,但在5年之内其镜下特点及病理分型均无统计学意义.初检位于左半结肠的CRA患者,复发息肉更易在左半结肠,而初检位于全结肠的患者复发息肉更易在全结肠.     

结肠镜检查中大肠腺瘤的漏诊率及漏诊相关危险因素

目的 明确结肠镜检查中大肠腺瘤的漏诊率及漏诊腺瘤特征,探讨腺瘤漏诊的相关危险因素.方法 患者在初次结肠镜检查发现并切除腺瘤后120 d内进行结肠镜复查,分析2次结肠镜检查结果.记录2次结肠镜检查所见腺瘤的特征(包括大小、部位、形态、数目及病理)、患者临床特征(包括年龄、性别、结肠镜检查原因、腹部及盆腔手术史、大肠憩室病史及是否行无痛结肠镜检查)及不同的内镜操作医师.分析不同类型腺瘤在结肠镜检查中的漏诊率以及腺瘤特征、患者临床特征和内镜医师的操作水平对腺瘤漏诊的影响.结果 809例患者中271例发生腺瘤漏诊,2次结肠镜检查共检出腺瘤2134颗,漏诊腺瘤425颗,腺瘤总漏诊率为20%(425/2134);平均患者腺瘤漏诊率为33%(271/809).腺瘤体积大者,漏诊率低(P<0.01);乙状结肠、肝曲、盲肠和升结肠部位的腺瘤以及平坦型腺瘤容易漏诊(P<0.05);患者腺瘤数越多在结肠镜检查中腺瘤漏诊率越高(P<0.01);初级内镜医师与有经验内镜医师相比,其漏诊率明显增加(P<0.01).结论 结肠镜检查中存在部分腺瘤漏诊,腺瘤漏诊与腺瘤大小、形态、部位、数目以及结肠镜检查操作医师密切相关.     

结肠镜检查中大肠腺瘤的漏诊率及漏诊相关危险因素

目的 明确结肠镜检查中大肠腺瘤的漏诊率及漏诊腺瘤特征,探讨腺瘤漏诊的相关危险因素.方法 患者在初次结肠镜检查发现并切除腺瘤后120 d内进行结肠镜复查,分析2次结肠镜检查结果.记录2次结肠镜检查所见腺瘤的特征(包括大小、部位、形态、数目及病理)、患者临床特征(包括年龄、性别、结肠镜检查原因、腹部及盆腔手术史、大肠憩室病史及是否行无痛结肠镜检查)及不同的内镜操作医师.分析不同类型腺瘤在结肠镜检查中的漏诊率以及腺瘤特征、患者临床特征和内镜医师的操作水平对腺瘤漏诊的影响.结果 809例患者中271例发生腺瘤漏诊,2次结肠镜检查共检出腺瘤2134颗,漏诊腺瘤425颗,腺瘤总漏诊率为20%(425/2134);平均患者腺瘤漏诊率为33%(271/809).腺瘤体积大者,漏诊率低(P<0.01);乙状结肠、肝曲、盲肠和升结肠部位的腺瘤以及平坦型腺瘤容易漏诊(P<0.05);患者腺瘤数越多在结肠镜检查中腺瘤漏诊率越高(P<0.01);初级内镜医师与有经验内镜医师相比,其漏诊率明显增加(P<0.01).结论 结肠镜检查中存在部分腺瘤漏诊,腺瘤漏诊与腺瘤大小、形态、部位、数目以及结肠镜检查操作医师密切相关.     

内镜下切除结直肠高危腺瘤随访166例

目的:探讨结直肠高危腺瘤内镜下切除后的复发特点.对今后高危腺瘤患者规范筛查和合理随访提出指导.方法:收集2004-01/2009-01发现结直肠高危腺瘤并经内镜下切除的患者详细临床资料.对于腺瘤切除后继续在我院内镜随访的患者进行登记.结果:共收集结直肠高危腺瘤497例患者,其中166例腺瘤切除后继续在我院行内镜随访.随访的166例患者一般资料分布:年龄32-82(平均61.64±11.07)岁,其中年龄≥55岁患者128例(128/166,77.11%),男性94例(94/166,56.63%),高危腺瘤以便血为首发症状的患者较多见(71/166,46.38%),且腺瘤表面易形成分叶(75/166,54.82%).首次复查时间为切除后1-28mo,共102例患者(102/166,61.45%)复发.高危腺瘤切除后的复发部位特点:初发于左半结肠的腺瘤易复发于左半结肠,初发于右半结肠的腺瘤易复发于右半结肠(r=0.440,0.387,均P<0.01),将高危腺瘤切除前后的病理表现进行比较未见明显相关性.Cox模型的风险量曲线图提示随时间的延长,从6mo开始患者息肉复发的风险逐渐增大.结论:结直肠高危腺瘤切除后存在...     

14例转移性结直肠癌合并消化道穿孔临床病理特征及预后的回顾性系列分析

目的分析转移性结直肠癌合并消化道穿孔病例临床病理特征及预后。方法采用描述性病例系列研究方法回顾性分析2019年11月至2020年11月北京大学肿瘤医院消化内科收治的转移性结直肠癌合并消化道穿孔的14例患者临床病理及穿孔前后CT影像特征。并将14例患者中穿孔后积极手术干预的12例患者分为2组:术后继续抗肿瘤治疗组和术后最佳支持治疗组,随访两组患者的生存状态,绘制生存曲线,采用Log-rank法比较两组患者生存曲线的差异。结果14例转移性结直肠癌合并消化道穿孔患者中,男性9例(64.3%)、年龄≥60岁10例(71.4%)、左半结肠癌10例(71.4%)、RAS/BRAF突变型10例(71.4%)、一线治疗11例(78.6%)、肠梗阻同时合并消化道穿孔8例(57.1%);14例晚期结直癌合并消化道穿孔的患者中有10例在抗肿瘤治疗中出现穿孔,其中使用血管内皮生长因子(vascular endothelial growth factor,VEGF)抑制剂7例,治疗有效8例。穿孔术后继续抗肿瘤组总生存期显著优于穿孔术后最佳支持治疗组,差异有统计学意义(P<0.05)。结论转移性结直肠癌合并消化道穿孔临床特征包括老年、男性、左半、RAS/BRAF突变、肠梗阻、影像学显示局部分期T_4a~T_4b、憩室等。另外,晚期肠癌治疗中使用血管生成抑制剂及抗肿瘤治疗有效时也需高度警惕消化道穿孔风险。转移性结直肠癌合并消化道穿孔积极手术干预后继续进行抗肿瘤治疗生存获益。     

Three randomized long-term surveillance trials in patients with sporadic colorectal adenomas

Objective. Guidelines for surveillance of patients with previous sporadic colorectal adenomas are based on retrospective long-term follow-up and prospective short-term studies. The aim of the present studies was to compare relative risk (RR) of new neoplasia as well as complications, using different intervals between examinations in long-term surveillance. Material and methods. Between l98l and l991, patients with pedunculated and small, flat and sessile adenomas were allocated at random to a 24 months (group A) or 48 months (group B) interval between surveillance colonoscopies (n=671). Patients with flat and sessile adenomas greater than 5 mm in diameter were randomized to intervals of 6 months (group C) or 12 months (group D) between l981 and 1987 (n=73). Finally, 200 patients with similar adenomas as in groups C and D were randomized to 12 months (group E) or 24 months (group F) from 1988 to 2000. The study ended in 2002. Results. Advanced adenomas were equally as frequent in group A and group B, but colorectal cancer (CRC) was found significantly more often in group B (RR?=?6.2 (1.0–117.4)). Severe complications occurred in 4 patients in group A and 2 patients in group B. Advanced new adenomas tended to be more frequent in group D than in C (p=0.08), but only one CRC was detected and this was in group C. There was no significant difference in the risk of CRC between the E and F groups, but the two cancers in group E were both early stage, in contrast to those in group F. Severe complications were seen in one patient in group E and also in group F. Conclusions. The results suggest that 2-year intervals should be used between colonoscopies in patients with previous pedunculated adenomas and small, flat and sessile adenomas, whereas larger, flat and sessile adenomas may need intervals of 1 year.     

Clinical study of sulindac in the treatment of sporadic colorectal adenomas

OBJECTIVE: To investigate the efficacy of sulindac in the treatment of sporadic colorectal adenomas. METHODS: Thirty‐six patients who were diagnosed colonoscopically and pathologically with sporadic colorectal adenomas were randomly divided into two groups. The sulindac group took 400 mg sulindac daily for 4 months and the patients in the control group were given a placebo treatment for the same period of time. All patients underwent pancolono­scopy at the end of the study. The number, size, morphology, and degree of atypia of the adenomas were compared before and after treatment. RESULTS: Four patients were dropped from the study (three in the sulindac group, one in the control group). Sixteen patients in each group completed the trial. In the sulindac group, the average diameter of 59 adenomas before treatment was 3.6 ± 2.2 mm, which was significantly larger than that after treatment (2.4 ± 1.5 mm; P < 0.001). The morphology of adenomas also changed significantly. The degree of atypia of adenomas also decreased after treatment (P < 0.001). No severe side‐effects of sulindac were found during the study. In the control group, the average diameters of adenomas before and after treatment were 4.6 ± 2.5 mm and 3.7 ± 2.2 mm, respectively. There was no significant difference between the average diameters of the adenomas before or after treatment (P > 0.05), nor was there any change in the morphology or the degree of atypia of the adenomas. CONCLUSIONS: Sulindac is effective in reducing the size and degree of atypia of adenomas. This trial demonstrated that sulindac has a regressive effect on sporadic colorectal adenomas. However, its long‐term effect remains to be tested.     

Comparison of malignant potential between serrated adenomas and traditional adenomas

BACKGROUND: Serrated adenoma is a discrete colorectal epithelial neoplastic lesion that can evolve into colorectal cancer. However, the degree of malignant potential has not been firmly established as yet. The purpose of the present paper was to compare the malignant potential and clinicopathological features between serrated and traditional adenomas. METHODS: A total of 124 serrated adenomas from 116 patients were assessed, and 419 traditional adenomas from 200 were randomly selected. The combination of nuclear dysplasia and serration of > or =20% of crypts was regarded as serrated adenoma. The clinicopathological features of serrated and traditional adenomas were compared, and multivariate analysis performed to confirm whether the malignant potential of serrated adenoma was similar to that of traditional adenoma. RESULTS: The differences in age, sex, total number of adenomas, and synchronous lesions including adenoma with high-grade dysplasia and carcinoma between subjects with and without serrated adenoma were not significant. Serrated adenomas were more frequently located in the rectum and sigmoid colon (P < 0.001), and the average size of serrated adenomas was greater than that of traditional adenomas (P < 0.05). The incidence of malignant lesions including high-grade dysplasia and carcinoma in serrated adenomas was found to be lower than in traditional adenomas (3.2% vs 9.3%, P < 0.05). In the multivariate analysis, adenoma type and polyp size constituted the risk factors for the incidence of high-grade dysplasia and carcinoma. CONCLUSIONS: Serrated adenoma is a premalignant lesion, but it has a lower potential for the development of malignancy than traditional adenomas.     

Development and validation of a risk score for advanced colorectal adenoma recurrence after endoscopic resection

AIM: To develop and validate a risk score for advanced colorectal adenoma(ACA) recurrence after endoscopic polypectomy.METHODS: Out of 3360 patients who underwent colon polypectomy at University of Foggia between 2004 and 2008, data of 843 patients with 1155 ACAs was retrospectively reviewed. Surveillance intervals were scheduled by guidelines at 3 years and primary endpoint was considered 3-year ACA recurrence. Baseline clinical parameters and the main features of ACAs were entered into a Cox regression analysis and variables with P 0.05 in the univariate analysis were then tested as candidate variables into a stepwise Cox regression model(conditional backward selection). The regression coefficients of the Cox regression model were multiplied by 2 and rounded in order to obtain easy to use point numbers facilitating the calculation of the score. To avoid overoptimistic results due to model fitting and evaluation in the same dataset, we performed an internal 10-fold cross-validation by means of bootstrap sampling. RESULTS: Median lesion size was 16 mm(12-23) while median number of adenomas was 2.5(1-3), whereof the number of ACAs was 1.5(1-2). At 3 years after polypectomy, recurrence was observed in 229 ACAs(19.8%), of which 157(13.5%) were metachronous neoplasms and 72(6.2%) local recurrences. Multivariate analysis, after exclusion of the variable "type of resection" due to its collinearity with other predictive factors, confirmed lesion size, number of ACAs and grade of dysplasia as significantly associated to the primary outcome. The score was then built by multiplying the regression coefficients times 2 and the cut-off point 5 was selected by means of a Receiver Operating Characteristic curve analysis. In particular, 248 patients with 365 ACAs fell in the higher-risk group(score ≥ 5) where 3-year recurrence was detected in 174 ACAs(47.6%) whereas the remaining 595 patients with 690 ACAs were included in the low-risk group(score 5) where 3-year recurrence rate was 7.9%(55/690 ACAs). Area under the curve of the model was 0.81(0.72-0.86) with an overall classification error rate of 0.09. The model was finally validated by means of 10-fold cross validation.CONCLUSION: Our study provides support for the use of a novel risk score as a clinical predictor of ACA recurrence after colon polypectomy.     

The effect of small or diminutive adenomas at baseline colonoscopy on the risk of developing metachronous advanced colorectal neoplasia: KASID multicenter study

BackgroundThe clinical significance of diminutive or small adenomas remains ill defined.AimsWe evaluated the clinical impact of diminutive or small adenomas at baseline on the risk of developing metachronous advanced colorectal neoplasia (CRN).MethodsThis multicenter, retrospective cohort study included 2252 patients with 1 or more colorectal adenomas at baseline and subsequent follow-up colonoscopy. Baseline colonoscopy findings were classified into 5 groups: 1 or 2 tubular adenomas (TAs) (<10 mm); 3–10 diminutive TAs (≤5 mm); 3–10 TAs, including 1 or 2 small adenomas (6–10 mm); 3–10 TAs, including 3 or more small adenomas; and advanced adenoma.ResultsIn multivariate analysis, after adjusting for possible confounding variables (age at baseline, sex, body mass index, smoking habits, family history of colorectal cancer, regular use of aspirin or NSAIDs, and adenoma location), 3–10 TAs including 3 or more small adenomas (hazard ratio [HR] = 2.36, p = 0.034) and advanced adenoma (HR = 2.14, p < 0.001) were independent predictors for the risk of developing metachronous advanced CRN. However, 3–10 diminutive TAs or 3–10 TAs, including 1 or 2 small adenomas, were not associated with this outcome.ConclusionsMultiplicity of diminutive TAs, without advanced lesions, showed no clinical significance for risk of developing metachronous advanced CRN.