叶酸对结直肠腺瘤性息肉的影响

叶酸是广泛存在于绿叶蔬菜中的水溶性B族维生素,在DNA的合成和复制中起重要作用。研究显示在正常结直肠黏膜中,叶酸缺乏易导致腺瘤性息肉发生;如结直肠腺瘤性息肉已形成,叶酸补充可能增加其进展风险。800μg/d的适量叶酸摄入是有益的,应不会增加结直肠腺瘤性息肉的发生风险。     

基质金属蛋白酶-2在不同病理类型的结直肠息肉患者中的表达及意义

目的 分析不同病理类型的结直肠息肉患者的基质金属蛋白酶-2(MMP-2)表达水平变化,探讨其在结直肠癌早期诊断中的价值.方法 选择2017年3月至2020年2月空军军医大学第一附属医院收治的150例结直肠息肉患者作为研究对象;另选择同期在该院就诊的30例结直肠癌患者,以及在该院体检的30名健康者(肠黏膜正常)纳入研究....     

老年人结直肠息肉的相关危险因素、内镜及病理特征

结直肠癌(colorectal cancer,CRC)是常见消化系统肿瘤之一,2020年全球癌症统计报告显示:全球CRC的发病率及死亡率分列第三位和第二位[1].结直肠息肉是位于结直肠内的隆起性病变,年龄作为结直肠息肉的相关危险因素一直备受关注.正确认识、了解老年人结直肠息肉的特点对老年人结直肠息肉及CRC的防治具有重...     

结直肠息肉的临床特征研究

目的 探讨不同类型结直肠息肉分布的临床特征.方法 收集444例结直肠息肉患者的临床资料,分析结直肠息肉与不同性别、年龄、检出部位、病理及直径大小之间的相关性.结果 结直肠息肉患者中男性构成比明显高于女性(男∶女=2.02∶1).检出部位在左半结肠患者比例明显高于右半结肠(64.6％比25.7％).不同病理类型中,腺瘤性...     

结直肠息肉切除后并发出血的研究进展

随着我国经济社会的发展,结直肠癌的发病率和死亡率在我国呈现出逐年上升的趋势,目前是我国发病率第四位的肿瘤。结直肠镜检查及内镜下息肉切除术是降低结直肠癌发病率和死亡率的重要手段]。出血、术后电凝综合征、穿孔和腹部不适是内镜下结直肠息肉切除术的主要并发症,其中以出血最常见。结直肠息肉切除后出血会引起一系列不良事件,包括：病人急诊观察、再次入院、重复内镜检查、内镜下止血、输血、血管造影栓塞甚至外科手术结直肠切除,对医院及患者而言均是较大的负担,本文对结直肠息肉切除后并发出血的研究进展做一综述,重点讨论结肠息肉切除后出血的流行病学、出血相关危险因素、出血后处置方法及预防出血措施,以期加深临床医师对此种并发症的认识,从而更好的指导临床工作。     

胆囊切除与结直肠息肉相关性的研究

背景：胆囊切除已被认为是结直肠癌的危险因素之一,但胆囊切除与结直肠息肉的关系一直未受到重视。目的：探讨胆囊切除与结直肠息肉的相关性。方法：连续收集经结肠镜排除恶性肿瘤、炎症性肠病、家族性腺瘤性息肉病等疾病的患者425例,根据既往有无胆囊切除史分为胆囊切除组（n=63）和对照组（n=362）,对两组患者结直肠息肉的发生率、内镜下息肉表现和组织学类型进行分析。结果：胆囊切除组结直肠息肉发生率高于对照组（46.0%对37.8%）,但差异无统计学意义（P=0.219）。两组患者息肉的部位和形态均无明显差异（P=0.753,P=0.127）;但胆囊切除患者腺瘤性息肉的发生危险显著高于对照组（OR=1.79,P=0.006）。亚组分析示胆囊切除史≥10年的结直肠息肉发生率与胆囊切除史〈10年无明显差异（P=0.11）。结论：胆囊切除并未增加结直肠息肉发生的危险性,但腺瘤性息肉的发生率显著增高,因此对胆囊切除患者应重视早期结直肠癌和腺瘤性息肉的筛查。     

结直肠大息肉的内镜下治疗

尽管大多数学者认为内镜下切除息肉是一个可行的措施，但是对于大息肉的治疗人们仍存在争议。本研究的目的是评价内镜下切除大息肉的可行性、有效性及安全性。     

排便习惯改变人群结直肠息肉患病率临床分析

背景:结直肠癌的发生与结直肠息肉,尤其是腺瘤性息肉密切相关。结直肠息肉患者常有排便习惯改变的表现。目的:分析排便习惯改变人群的结直肠息肉患病率及其临床病理特点,以期指导此类个体的干预和治疗。方法:收集2009~2012年因排便习惯改变至上海瑞金医院卢湾分院行结肠镜检查的患者,对其息肉检出率、病理类型和分布情况进行回顾性分析。结果:共6 204例患者入选,结直肠息肉检出率为32.2%(1 997例),男性检出率显著高于女性(38.8%对26.2%,P0.01)。有病理记录的息肉共3 041枚,其中腺瘤性息肉1 798枚(59.1%),增生性息肉592枚(19.5%),炎性息肉554枚(18.2%),腺癌83枚(2.7%),227枚(12.6%)腺瘤性息肉伴有低级别或高级别上皮内瘤变。息肉、腺瘤、腺癌分布于肝曲远端者均在80%以上。结论:排便习惯改变人群的结直肠息肉患病率较高且以腺瘤性息肉为主,病变多位于肝曲远端。对此类患者应尽早行全结肠镜检查/治疗,从而有效预防结直肠癌的发生。     

非酒精性脂肪肝与结直肠腺瘤性息肉的相关性

目的探讨非酒精性脂肪肝（NAFLD）和结直肠腺瘤性息肉的相关性。方法选择我院2008年10月-2013年5月完善肠镜检查和相关辅助检查资料完整的住院患者2 165例,随机分为结直肠腺瘤性息肉组413例及正常对照组1 752例。统计两组NAFLD患病率,并采用多因素Logistic回归分析NAFLD与结直肠腺瘤性息肉的关系。结果结直肠腺瘤性息肉组NAFLD患病率高于正常对照组（P〈0.05）。多因素Logistic回归分析结果显示,NAFLD是结直肠腺瘤性息肉的独立高危因素（OR：1.16;95%CI：1.04-1.58）。结论 NAFLD可增加患结直肠腺瘤性息肉的风险。     

遗传性非息肉病性结直肠癌家系临床病理特征分析

目的 探讨中国人遗传性非息肉病性结直肠癌(HNPCC)家系发病特点及预后.方法 收集24个符合Amsterdam标准的HNPCC家系,绘制其家系图谱、收集临床病理及随访资料,分析中国人HNPCC的发病特点及预后.结果 24个HNPCC家系中,共有肿瘤患者116例(其中先证者多原发癌16例,家系成员多原发癌9例),发病年龄19～74岁,其中结直肠癌灶120个,肠外相关肿瘤32个.在24个HNPCC家系的先证者中,患第一结直肠癌的平均年龄为42.5岁,男性多于女性,右半结肠肿瘤多于左半结肠;肿瘤分化均较好,以中分化多见,病理类型以管状腺癌多见,占45.8%(11/24);截至随访结束时,术后生存≥5年者共14例,占58.3%(14/24),其中9例超过10年,最长1例存活时间已达27年.结论 中国人HNPCC以中分化管状腺癌多见,发病年龄较轻,右半结肠癌多见.     

Physician accuracy in diagnosing colorectal polyps

Since the medical management of persons with adenomatous colorectal polyps differs from that of those with hyperplastic polyps, accuracy of diagnosis is essential. Although many physicians have grown confident that their skills of visual diagnosis are adequate, few data exist to support this confidence. In order to examine the accuracy of physicians' judgments regarding colorectal polyp histology, the visual diagnosis of physicians experienced in endoscopy was compared with the histologic report. Eighty-one polyps were discovered by flexible sigmoidoscopy among 718 participants in a colon cancer screening program. Eighty percent of all polyps were detected accurately. The diagnostic sensitivity of detecting adenomas was 69 percent, while specificity (accurate diagnosis of hyperplastic polyps) was 86 percent, and there were an additional eight false negative and eight false positive diagnoses. Further analyses revealed that there are individual patterns of diagnostic mistakes made by physicians and that mistakes frequently are related to polyp size. These findings are particularly important in light of the expanding numbers of relatively inexperienced primary care providers performing flexible sigmoidoscopy whose diagnoses may be strongly dependent on polyp size. This research was done through, and supported by, the Center for Occupational Health, Department of Family Medicine, Wayne State University, Detroit, Michigan.     

Endoscopic management of large colorectal polyps

Objectives  The optimal treatment for large colorectal polyps (LCPs) is still a controversial issue. The aim of this study was to evaluate the safety and effectiveness of endoscopic polypectomy (EP) of colorectal polyps ≥2 cm in size. Patients and methods  One hundred fifty-one EP LCPs were performed over a period of 7 years. Diathermal snare was used for pedunculated and pseudopedunculated polyps and endoscopic mucosal resection (EMR) or biopsy forceps polypectomy for sessile and flat polyps. The resected polyps were recovered and collected for histology. At scheduled follow-up visits 1, 3, 6, and 12 months after polypectomy, complications and recurrences were recorded in all patients. Results  Fifteen polyps were located in the rectum, 84 in the sigmoid colon, 11 in the descending colon, four in the splenic flexure, 11 in the transverse colon, 11 in the hepatic flexure, seven in the ascending colon and eight in the cecum. Fifty-six polyps were sessile, 54 pedunculated, 25 pseudopedunculated, and 16 flat. At histology, most of polyps (131) were adenomas (nine with adenocarcinoma in situ). Five were invasive polypoid carcinomas and required colonic resection. Immediate bleeding occurred in ten patients (7.6%) and it was stopped by endoscopic hemoclips (7), epinephrine injection (1), or surgery (2). There were three perforations (2.3%; all polypoid carcinomas), managed endoscopically (1) or surgically (2). Delayed bleeding occurred in two patients (1.5%) and was treated by endoscopic diathermy and hemoclips (1) or surgery (1). During follow-up, six (4.6%) incompletely excised polyps and three (2.3%) relapses in the site of previous EP were detected and endoscopically removed. Conclusion  EP is relatively safe and effective for benign-appearing LCPs.     

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.     

内镜下黏膜切除术治疗胃肠道息肉样病变的70例临床分析

目的 探讨内镜下黏膜切除术（ endoscopic mucosal resection,EMR） 在切除胃肠道息肉中的应用价值.方法 回顾性分析70例（82枚息肉）行EMR治疗胃肠道息肉的临床资料.结果 30例患者40枚胃息肉及40例患者42枚结肠息肉经EMR 治疗后,病变均完整切除,无出血、感染和穿孔等并发症发生.结论 EMR是临床上治疗胃肠道息肉的一种安全有效的内镜治疗手段,值得临床推广.     

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。     

Endoscopic management of colorectal polyps: From benign to malignant polyps

Colorectal cancer(CRC) is the third most common cancer worldwide and the second leading cause of cancer related death in the world. The early detection and removal of CRC precursor lesions has been shown to reduce the incidence of CRC and cancer-related mortality. Endoscopic resection has become the first-line treatment for the removal of most precursor benign colorectal lesions and selected malignant polyps. Detailed lesion assessment is the first critical step in the evaluation and management of colorectal polyps. Polyp size, location and both macro-and micro-features provide important information regarding histological grade and endoscopic resectability. Benign polyps and even malignant polyps with superficial submucosal invasion and favorable histological features can be adequately removed endoscopically. When compared to surgery, endoscopic resection is associated with lower morbidity, mortality, and higher patient quality of life. Conversely, malignant polyps with deep submucosal invasion and/or high risk for lymph node metastasis will require surgery. From a practical standpoint,the most appropriate strategy for each patient will need to be individualized,based not only on polyp-and patient-related characteristics, but also on local resources and expertise availability. In this review, we provide a broad overview and present a potential decision tree algorithm for the evaluation and management of colorectal polyps that can be widely adopted into clinical practice.     

FICE技术10组波长对大肠息肉的诊断价值

目的:探讨FICE放大内镜10组波长组合对大肠息肉的观察效果,并选出最佳波长组合.方法:选择武汉大学人民医院 2007-05/2010-05进行常规内镜检查,资料保存完整的大肠息肉患者378例.采用FICE放大技术预先设定的10组波长分别对病变进行腺管开口分型及毛细血管形态观察,并对图像清晰度进行评分,选出最佳波长组合...     

结直肠息肉、结直肠癌的特点及与幽门螺杆菌感染相关性的研究

目的 探讨结直肠息肉、结直肠癌临床与病理的特点及其与幽门螺旋杆菌(Helicobacter pylori,H.pylori)感染的相关性.方法 收集安徽医科大学第二附属医院2018年7月至2020年9月同时行肠镜及幽门螺旋杆菌血清学抗体检测的患者资料共460例,并分为结直肠息肉组、结直肠癌组、正常对照组,回顾性分析结直...     

Follow-up colonoscopy in patients with colorectal adenomatous polyps

Forty-four asymptomatic patients with adenomatous colorectal polyps were followed by repeated colonoscopies and subsequent removal of new polyps. The median follow-up time was 34 months (range, 4 to 131 months). Twenty-six patients (59 percent) developed new adenomatous polyps. Therecurrence rate was 69 percent in patients with multiple polyps compared with 54 percent in patients with a single polyp. The location of new polyps was in the same colonic segment in 81 percent of the patients, but not at the same site in the colon where a previous polyp had been removed. The histopathology and size of new polyps compared with the initial polyps showed a significant improvement in histopathology toward more benign polyps (P<0.02) and smaller polyps (P<0.001). In patients who initially had single adenomatous polyps, new polyp(s) were diagnosed after a mean time of 23 months compared initially. Patients with atypia in initial polyp(s) developed new polyp(s) after a mean time of 11 months compared with 23 months in patients without atypia. The mean time from a colon with no polyps to the diagnosis of a new adenomatous polyp less than 5 mm in size was 11.5 months, which was a statistically significant shorter time than the 19.4 months observed for the development of polyps 5 mm or larger.     

结直肠侧向发育型肿瘤并发结直肠息肉的预测因子及发生恶变的危险因素

目的探究结直肠侧向发育型肿瘤(colorectal laterally spreading tumors, CLST)并发结直肠息肉的独立预测因子及CLST合并结直肠息肉发生恶变的独立危险因素。方法回顾性收集2016年1月—2021年12月在大连医科大学附属第二医院行内镜检查发现CLST, 并接受内镜下治疗的260例患者的临床资料。根据是否与结直肠息肉共存将CLST患者分为共存组(n=135)与非共存组(n=125), 比较两组的临床病理特征差异, 采用二元Logistic回归分析共存现象的预测因子。根据共存组CLST的浸润深度, 将共存组分为共存恶性组(n=38)与共存非恶性组(n=97), 采用二元Logistic回归分析CLST合并结直肠息肉发生恶性变的危险因素。结果男性(P=0.002, OR=2.355, 95%CI:1.354～4.099)、绒毛管状腺瘤(P=0.022, OR=3.873, 95%CI:1.214～12.355)、既往有息肉病史(P=0.001, OR=2.738, 95%CI:1.527～4.909)是CLST合并结直肠息肉的独立危险因素。该预测模型受试...