老年人大肠息肉无痛结肠镜切除术结肠镜结果分析

目的探讨无痛结肠镜下老年人大肠息肉切除术后病理及镜下特点。方法回顾性分析117例老年人大肠息肉的临床资料、内镜和病理特点,分析老年患者息肉的病理学、内镜特点（分布、大小、形态）及癌变情况,并与同期中青年患者进行比较。结果所有人群的息肉均好发于左半结肠（直肠、乙状结肠、降结肠）;老年患者息肉检出率高于中青年患者（35.67%vs 9.50%）（P〈0.01）;老年人息肉以腺瘤性息肉最为多见（60.71%）,息肉癌变率高（4.29%）,均高于中青年组（P〈0.05）;老年组直径≥1 cm的息肉和分叶状息肉也多于中青年组（P〈0.05）。结论肿瘤大小、病理类型、发生部位和年龄为腺瘤发生不典型增生的4个最重要的风险因子,老年大肠息肉患者具有以上危险因素。对老年人大肠息肉应该遵循＂见瘤即切＂的原则并密切随访。     

如何提高结肠镜检查对结直肠肿瘤的检出率

近年来,中国结直肠肿瘤的患病率明显上升,且呈年轻化趋势,结肠镜检查是目前公认的结直肠肿瘤诊断的金标准,但存在一定的局限性,此文通过分析近年来国内外在结肠镜方面的研究,结合几种新兴的内镜检查技术,阐述了如何提高结肠镜检查对结直肠肿瘤的检出率。     

结肠镜筛查203例无症状人群结直肠癌及腺瘤检出率分析

目的了解澳门无症状人群通过肠镜筛查的结直肠癌及腺瘤检出率及其临床特征。 方法选择2012年1月至12月于我院进行肠镜检查的无症状人群203例,回顾性分析其临床特征和病理活检结果,并分析肠癌及腺瘤患者的高危因素。 结果203例受检者中检出结肠癌3例(1.48%),腺瘤70例(34.48%),其中高危腺瘤30例(14.78%)。60岁以上受检者腺瘤检出率高于50岁以下受检者(P＝0.013),有吸烟史人群高危腺瘤检出率高于无吸烟史者(P＝0.037)。 结论对无症状人群的全结肠镜筛查有助于早期发现肠癌及腺瘤。年龄大于60岁是结肠腺瘤的高危因素,吸烟史是结肠高危腺瘤的高危因素。     

大肠癌高危人群结肠镜检查追踪随访

目的：大肠癌在消化道肿瘤中预后较好,如能较早的发现和及时治疗,完全可以根治。方法：对1125例大肠癌高危人群进行结肠镜的追踪随访检查,结果：发现大肠癌37例（3．3％）,其中28例（75．7％）为无淋巴结转移的早期癌,发现癌前期病变一大肠腺瘤215例（19．1％）。结论：结肠镜对大肠癌高危人群进行定期追踪检查是发现早期大肠癌和癌前期病变－腺瘤最方便、最安全、最简便的方法。     

大肠癌术后患者结肠镜随访检查的意义

目的 通过大肠镜检查在临床的广泛应用,防止和降低多原发大肠癌的发生.方法 分析1986年6月至2007年6月大肠癌外科术后进行无症状定期结肠镜随访2762例患者的资料,随访方法为术后3～6个月内首次肠镜检查,以后每年1次,连续3年.并与1981年9月至1986年5月大肠癌术后有症状者结肠镜复查的218例资料进行对比.结果 2762例中发现多原发癌48例,其中同时多原发癌39例(1.4%),异时多原发癌9例(0.3%);TNM分类Ⅰ期癌6例,Ⅱ期癌31例,Ⅲ期癌11例.发现腺瘤583例(21.1%),病理检查证实17例(3.2%)为浸润性早期癌,58例(9.9%)为高级别上皮内瘤变.218例有症状检查者共发现多原发癌27例(12.4%),明确Ⅰ期癌4例,Ⅱ期癌6例,Ⅲ期癌16例.发现腺瘤29例(13.3%).结论 无症状定期结肠镜随访检查发现多原发癌明显低于有症状者,发现的早期癌、腺瘤比例高,说明无症状定期检查,能防止和降低多原发大肠癌的发生.     

233例结直肠腺瘤摘除术后随访和内镜监测的临床分析

目的 了解结直肠腺瘤(CRA)摘除后复发情况和结肠镜监测现状,探讨CRA复发的相关危险因素.方法 收集2005年6月至2009年12月安徽医科大学第一附属医院符合研究标准283例CRA摘除住院患者临床资料并进行随访.统计分析CRA摘除后复发率,结肠镜监测间期和CRA复发的关系及CRA复发的相关危险因素;分析肠镜监测组监测间期、频次,及未行监测的原因.结果 共随访CRA摘除后患者235例,随访率83.0％(235/283),其中生存患者233例,随访时间最短者12个月,最长66个月,随访时间中位数为(35.1±14.2)个月.结肠镜监测组患者115例,监测率为49.4％(115/233),复发率45.0％(50/111),未监测组118例;年龄≥60岁、体重指数≥25kg/m2、多发腺瘤(≥2个)与CRA复发明显相关,差异有统计学意义(x2值分别=4.299、5.291和8.883,P值分别=0.038、0.021和0.027);未监测组患者对CRA需要定期监测的知晓率明显低于监测组,差异有统计学意义(x2=37.819,P＜0.01).结论 CRA摘除术后复发率较高;高龄、高体重指数、多发腺瘤是预测CRA复发的独立危险因素;我院CRA摘除后结肠镜监测率低,主要原因在于患者对CRA摘除后定期监测重要性的认识不足.     

石河子地区近十年结肠镜成人结直肠癌及腺瘤检出情况的横断面调查

目的　调查石河子地区近十年结肠镜下成人结直肠癌（colorectal cancer,CRC）、结直肠腺瘤和进展期腺瘤检出率的变化趋势。方法　2010年1月1日—2019年12月31日期间,就诊于石河子大学医学院第一附属医院完成结肠镜检查的病例纳入调查,通过查阅电子病历系统收集病历资料,具体信息包括患者年龄、性别及结直肠腺瘤或CRC的部位、数量、大小和病理类型等。主要观察结直肠腺瘤、结直肠进展期腺瘤和CRC的检出率,包括10年总体检出率以及前五年（2010—2014年）总体检出率和后五年（2015—2019年）总体检出率。结果　共纳入50 645例,经排除标准排除14 931例,最终共35 714例纳入数据分析。结直肠腺瘤、结直肠进展期腺瘤和CRC的10年总体检出率分别为17.65%（6 302/35 714）、4.45%（1 589/35 714）和3.71%（1 324/35 714）。结直肠腺瘤后五年总体检出率［20.33%（4 565/22 457）］高于前五年［13.10%（1 737/13 257）］;结直肠进展期腺瘤后五年总体检出率［4.69%（1 053/22 457）］高于前五年［4.04%（536/13 257）］;CRC后五年总体检出率［3.30%（741/22 457）］低于前五年［4.40%（583/13 257）］。结论　石河子地区2015—2019年结直肠腺瘤检出率较2010—2014年有较大幅度升高,结直肠进展期腺瘤检出率较2010—2014年有小幅升高,而CRC检出率较2010—2014年有小幅下降,由此推测结肠镜检查发现并切除结直肠腺瘤对降低CRC发病率可能具有重要作用。     

结直肠癌平均风险人群结肠镜检查盲肠进镜失败现状及原因

目的:获得我国结直肠癌平均风险人群结肠镜检查中盲肠进镜失败比例,分析失败病例特点并探讨导致进镜失败的原因.方法:采用回顾性分析方法,调取2008-01/2010-09于上海长海医院结肠镜检查室进行结肠镜检查的患者资料,按受检原因筛选平均风险人群,按照是否完成盲肠进镜分为两组,组间性别、年龄、肠道准备质量和息肉检出率差异应用χ2检验.对盲肠进镜失败原因进行描述性分析.结果:共有10164名平均风险受检者接受了结肠镜检查,其中盲肠进镜失败组613人,占6.0%.与盲肠进镜成功组患者相比,盲肠进镜失败组患者平均年龄和息肉检出率更高、肠道准备质量较差(P<0.05),性别比例无显著差别.导致狭窄的占位性病变是盲肠进镜失败的首要原因,肠道准备欠佳次之.盲肠进镜失败组中共检出浸润癌253例,浸润癌检出率为41.27%.结论:高龄、肠道准备欠佳是盲肠进镜失败的相关因素.盲肠进镜失败时腺瘤检出率偏高的现象与浸润癌的检出关系密切.我国平均风险人群结直肠进展期肿瘤检出率偏高.     

223例获得性免疫缺陷综合征患者的结肠镜检查结果分析

目的 分析223例获得性免疫缺陷综合征(AIDS)患者的结肠镜检查结果。方法 AIDS患者223例,均采用电子结肠镜进行检查,分析结肠镜检查结果。结果 结肠镜下可见异常者134例,其中结直肠息肉82例(单发者38例、多发者44例,息肉位置位于左半结肠39例、右半结肠31例、全结肠12例,山田Ⅰ型47例、Ⅱ型27例、Ⅲ型5例、Ⅳ型3例),结直肠炎45例,恶性肿瘤4例,尖锐湿疣3例。结直肠息肉中,炎性息肉11例、增生性息肉43例、腺瘤性息肉28例;结直肠炎中,非特异性炎症38例、病毒感染所致的炎症2例、慢性肉芽肿性炎3例、阿米巴肠炎1例、缺血性肠炎1例;恶性肿瘤中,直肠早期卡波西肉瘤1例、直肠鳞状细胞癌2例、直肠神经内分泌肿瘤1例。CD4+T淋巴细胞计数<200个/mm³、≥200个/mm³的结直肠炎者分别为32、13例,结直肠息肉者分别为68、14例,恶性肿瘤者分别为3、1例,尖锐湿疣者分别为2、1例,两者比较,P均<0.05;艾滋病病毒载量(HIV-RNA)阳性、阴性的结直肠炎者分别为30、15例,结直肠息肉者分别为65、17例,...     

自身荧光成像电子内镜技术能否增加结肠镜息肉检出率的初步研究

结直肠癌是全球范围内最常见的恶性肿瘤之一,其最有效的预防措施为早期发现并切除结直肠腺瘤。目前,结肠镜检查被公认为是诊断和治疗结直肠息肉的金标准,但常规结肠镜检查对病灶有一定漏诊率。研究表明腺瘤≥1cm时漏诊率为6％,6-9mm时为13％,≤5mm时为27％;右半结肠腺瘤的漏诊率有高于左半结肠的趋势（27％对21％）。     

70岁以上老年人腹腔镜结直肠癌手术的安全性

目的探讨腹腔镜手术治疗70岁以上老年人结直肠肿瘤的安全性。方法回顾性总结113例腹腔镜辅助和开腹结直肠手术治疗70岁以上老年人结直肠肿瘤的经验,比较腹腔镜手术组(腹腔镜组)35例、传统开腹手术组(开腹组)78例和65岁以下腹腔镜手术组(对照组)35例的手术安全性、并发症及随访结果等情况。结果腹腔镜组、对照组无手术相关死亡患者,开腹组有2例因术后肺部感染而死亡。腹腔镜组有7例(20.0%)发生术后并发症,显著少于开腹组的33例(42.3%)(P<0.05).而与对照组的3例(8.6%)比较,差异无统计学意义。腹腔镜组术中出血、排气时间与进食半流质时间分别为(92±50)ml、(2±1)d 和(5±2)d,与开腹组(156±119)ml、(3±3)d和(6±1)d 比较,差异有统计学意义(P<0.05)。腹腔镜组与对照组手术时间、术中出血及主要并发症差异无统计学意义(P>0.05)。腹腔镜组与开腹组短期内(30个月)肿瘤局部复发、远处转移率类似,累计生存率(仅肿瘤相关死亡)分别为80.4%与82.1%,差异无统计学意义。结论腹腔镜手术治疗70岁以上老年人结直肠癌安全、有效,是治疗老年人结直肠肿瘤较好的选择方法。     

普通窄带成像内镜对结直肠增生性息肉和腺瘤的鉴别诊断价值

目的 分析普通窄带成像(NBI)内镜下结直肠增生性息肉与腺瘤腺管及微血管特征的差异,评价NBI的鉴别诊断价值.方法 将普通内镜下诊断结直肠息肉、病理检查证实为增生性息肉或腺瘤者纳入研究并进行NBI内镜检查.将腺管形态参照改良的工藤分型法分为A型和B型.将微血管形态分为3型,无微血管判为Ⅰ型,微血管沿腺管开口排列、粗细均匀判为Ⅱ型,微血管粗细不均、排列紊乱判为Ⅲ型.比较增生性息肉和腺瘤NBI图像中腺管形态和微血管形态特征的差异,同时对无放大NBI图像观察者间的一致性进行评价.结果 共87例患者的107个息肉(腺瘤73个、增生性息肉34个)进行普通NBI内镜检查.腺瘤组息肉最大径和表面分叶者比例明显高于增生性息肉组(P值分别=0.0023和0.0047).腺瘤组中B型腺管形态[86.3％(63/73)]及Ⅱ或Ⅲ型微血管形态[82.2％(60/73)]者较多.以B型腺管形态、Ⅱ型或Ⅲ型微血管中任一特征诊断腺瘤的敏感度、特异度、准确率分别为97.3％、82.4％、92.5％.以B型腺管形态联合Ⅱ型或Ⅲ型微血管诊断腺瘤的敏感度、特异度、准确率分别为71.2％、91.2％、77.6％.观察者间一致性评价平均Kappa值为0.761.结论 普通NBI内镜下结直肠腺瘤和增生性息肉的微血管特征和腺管特征存在差异,依据以上两方面可在NBI内镜下实时初步鉴别腺瘤和增生性息肉.     

Retrograde inspection vs standard forward view for the detection of colorectal adenomas during colonoscopy: A back-to-back randomized clinical trial

BACKGROUND The adenoma detection rate(ADR) is inversely associated with the incidence of interval colorectal cancer and serves as a benchmark quality criterion during screening colonoscopy. However, adenoma miss rates reach up to 26% and studies have shown that a second inspection of the right colon in retroflected view(RFV) can increase ADR.AIM To assess whether inspection of the whole colon in RFV compared to standard forward view(SFV) can increase ADR.METHODS Patients presenting for screening or surveillance colonoscopy were invited to participate in this randomized controlled trial and randomized into two arms. In RFV arm colonoscopy was initially performed with SFV, followed by a second inspection of the whole colon in RFV. In the SFV arm first withdrawal was performed with SFV, followed by a second inspection of the whole colon again with SFV. Number, size and morphology of polyps found during first and second inspection in each colonic segment were recorded and all polyps were removed and sent for histopathology in separate containers.RESULTS Two hundred and five patients were randomly assigned to the RFV(n = 101) and SFV(n = 104) arm. In the RFV arm, both polyp detection rate(PDR) and ADR were increased under second inspection in RFV(PDR 1~(st) SFV: 39.8%, PDR 2~(nd)RFV: 46.6%; ADR 1~(st) SFV: 35.2%, ADR 2~(nd) RFV: 42%). Likewise, in the SFV arm,PDR and ADR were increased under second inspection(PDR 1~(st) SFV: 37.5%, PDR 2~(nd) SFV: 46.6%; ADR 1~(st) SFV: 34.1%, ADR 2~(nd)SFV: 44.3%) with no significant differences in ADR and PDR between the SFV and RFV arm. Mean number of adenomas per patient(APP) was increased in the RFV and SFV(APP RFV arm: 1~(st) SFV: 1.71; 2~(nd) RFV: 2.38; APP SFV arm: 1~(st) SFV: 1.83, 2~(nd)SFV:2.2). The majority of adenomas additionally found during second inspection in RFV or in SFV were located in the transverse and left-sided colon and were 5 mm in size.CONCLUSION Second inspection of the whole colon leads to increased adenoma detection with no differences between SFV and RFV. Hence, increased detection is most likely a feature of the second inspection itself but not of the inspection mode.     

Flat Lesions of the Colorectal Mucosa: Differences in Recognition Between Japanese and American Endoscopists

INTRODUCTION: Flat lesions of the colorectal mucosa have been a topic of debate since they were first described. Japanese series suggest that flat adenomas represent up to 25 percent of all colorectal adenomas and that they are a particularly advanced form of neoplasia for their size. Series published by Western endoscopists show a lower incidence and a lower degree of dysplasia. We performed this study to see whether American colonoscopists interpret the shape of lesions of the colorectal mucosa differently from their Japanese colleagues.METHODS: A book of endoscopic photographs of 50 small lesions of the colorectal mucosa was shown to 11 American and 8 Japanese colonoscopists. The colonoscopists were asked to decide whether each lesion was sessile, flat, depressed, pedunculated, or that there was no polyp present. Results were tabulated by lesion and by endoscopist.RESULTS: Although the average number of lesions deemed sessile was similar between groups (American, 33.8 ± 2.1 95 percent confidence interval; Japanese, 29.4 ± 2.2) there were marked differences in determination of flat lesions (American, 5.3 ± 1.5; Japanese, 14.5 ± 2.2), depressed lesions (American, 0.8 ± 0.4; Japanese, 2.4 ± 0.7) and those deemed no polyp (American, 5.1 ± 0.9; Japanese 0). At least six of the eight Japanese colonoscopists agreed that a particular lesion was flat on 12 occasions, but American colonoscopists agreed on only 1 of these. Six of eight Japanese colonoscopists agreed on lesions as sessile in 27 cases, with Americans agreeing in 25 of these.CONCLUSIONS: There are significant differences in interpretation of the shape of lesions of the colorectal mucosa between Japanese colonoscopists and their American counterparts. These differences are likely to account for some of the apparent differences in incidence in series of flat colorectal adenomas reported from Japan and Western countries.Reprints are not available.     

仿真CT肠镜在结直肠增殖性病变诊断中的应用

目的 评估仿真ＣＴ肠镜在结直肠镜证实的增殖性病灶中的检出能力及其临床应用前景。方法 ２３例结肠镜检查发现异常的患者在１ｈ内行腹腔和盆腔薄层螺旋ＣＴ扫描,扫描数据经特殊软件处理后作二维和三维图像重建,将ＣＴ肠镜诊断结果与全结肠镜、病理和手段结果进行对比研究。结果 ２０例结肠镜诊断为结直肠癌的１例为结肠狭窄原因待查者。ＣＴ肠镜诊断为结肠癌,并得到病理和手术证实;１１ｍｍ以上的结直肠息肉结肠镜和ＣＴ肠镜     

Surgery for large bowel cancer in people aged 75 years and older

Three hundred ten predominantly male patients who were 75 years of age or older and had surgery for colorectal carcinoma had a hospital mortality rate of 9 percent and a cancer-related five-year survival of 50 percent. These results and a detailed analysis of the causes of complications and mortality were compared with the outcome of 710 patients who were treated concurrently and who were younger than 75 years. Tumors in older patients had a tendency to occur on the right side and were more locally advanced. Increased mortality was particularly attributable to sepsis and cardiovascular causes. Increased morbidity was due principally to respiratory and urinary problems. There were no significant differences, however, in wound or anastomotic complications, nor was therapy for the older patients more costly. The indications for surgical resection for colorectal cancer in patients aged 75 years and older should be the same as those for any younger group. Read at the XIth Biennial Congress of the International Society of University Colon and Rectal Surgeons, May 4 to 8, 1986, Dallas, Texas. Supported by the Department of Veterans' Affairs and Telmak Pfy., Ltd.     

The mean number of adenomas per procedure should become the gold standard to measure the neoplasia yield of colonoscopy: A population-based cohort study

BackgroundMeasuring adenoma detection is a priority in the quality improvement process for colonoscopy. Our aim was (1) to determine the most appropriate quality indicators to assess the neoplasia yield of colonoscopy and (2) to establish benchmark rates for the French colorectal cancer screening programme.MethodsRetrospective study of all colonoscopies performed in average-risk asymptomatic people aged 50–74 years after a positive guaiac faecal occult blood test in eight administrative areas of the French population-based programme.ResultsWe analysed 42,817 colonoscopies performed by 316 gastroenterologists. Endoscopists who had an adenoma detection rate around the benchmark of 35% had a mean number of adenomas per colonoscopy varying between 0.36 and 0.98. 13.9% of endoscopists had a mean number of adenomas above the benchmark of 0.6 and an adenoma detection rate below the benchmark of 35%, or inversely. Correlation was excellent between mean numbers of adenomas and polyps per colonoscopy (Pearson coefficient r = 0.90, p < 0.0001), better than correlation between mean number of adenomas and adenoma detection rate (r = 0.84, p = 0.01).ConclusionThe mean number of adenomas per procedure should become the gold standard to measure the neoplasia yield of colonoscopy. Benchmark could be established at 0.6 in the French programme.     

结直肠锯齿状癌变途径的分子基础

锯齿状癌变途径是近年提出的概念．用来解释一部分缺乏染色体不稳定性结直肠癌的发生，包括部分增生性息肉、无蒂锯齿状息肉、锯齿状腺瘤和混合性息肉。早期发生BRAF突变、DNA高甲基化以及微卫星不稳定是大部分这类息肉的分子特征．经典的Wnt信号通路在这条途径中可能不起主要作用。     

结直肠锯齿状病变的微卫星状态研究

目的 比较结直肠锯齿状病变与传统腺瘤、腺癌的微卫星状态的差异,以期间接验证传统型锯齿状成瘤通路的存在.方法 收集北京军区总医院病理科保存的75例大肠息肉及肿瘤组织蜡块标本,其中锯齿状腺癌(Sca)15例,非锯齿状腺癌(N-Sca)20例,传统型锯齿状腺瘤(TSA)20例,普通腺瘤20例.抽提基因组DNA,采用荧光标记引物扩增BAT25、BAT26两个位点,随后使用DNA自动测序仪检测其微卫星状态,并对实验结果进行统计学分析.结果部分标本扩增失败,对于成功扩增的68例标本:18例TSA中6例为高度微卫星不稳定型(MSI-H),12例为低度微卫星不稳定型(MSI-L)/微卫星稳定型(MSS);18例普通腺瘤均为MSS;13例Sca中3例为MSI-H,10例为MSI-L/MSS;19例N-Sca中仅1例为MSI-H,18例为MSI-L/MSS.统计学分析表明,普通腺瘤组、N-Sca组MSI-H发生率明显低于TSA组和Sca组(P<0.05),而后两组间差异无统计学意义(P>0.05).结论 与普通腺瘤、N-Sca相比,MSI-H更多见于TSA、Sca,由此推断存在一条有别于传统"腺瘤-癌"发生模式的传统型锯齿状成瘤通路,但尚需大规模前瞻性研究确认.