1578例大肠息肉的病理类型与癌变因素探讨

目的:探讨大肠息肉的各种病理类型与癌变相关因素.方法:选择2002年1月至2011年12月在本院肠镜检查检出大肠息肉患者1578例,回顾性研究大肠息肉的发病年龄、部位、大小、形态、病理类型与癌变因素.结果:大肠息肉检出率为22.72%,癌变率5.64%;不同年龄检出率有统计学差异(X2=8.250,P=0.016),中年患者检出率高;大肠息肉在直肠(32.00%)乙状结肠检出(35.80%)最常见,息肉直径≤1cm较常见(78.90%),在直径1cm-2cm的息肉中腺瘤性息肉占比最高(70.12%),形态研究发现无分叶状息肉较常见(80.04%);癌变因素研究发现老年患者(X2=10.070 P=0.002)、发生部位在直肠及乙状结肠(X2=0.843 P=0.016)、息肉直径>2cm(X2=114.173 P<0.001),分叶状息肉(X2=16.66 P<0.001)、三种腺瘤性息肉(X2=71.14 P<0.001)较其它因素癌变率显著增加.结论:大肠息肉的发病与年龄性别密切相关;不同病理类型的大肠息肉临床特点明显不同;直肠和乙状结肠、分叶、腺瘤性、直径>2.0cm的息肉是发生癌变的高危因素;对大肠息肉须及时治疗,定期随访,减少大肠癌的发生.

The Pathological Type and Carcinogenesis Factors on 1578 Cases of Colorectal Polyp

Objective: To investigate the various pathological types of colorectal polyps and carcinogenesis-related factors.Method: 1578 cases of colorectal polyps detected by colonoscopy in our hospital from January 2002 to December 2011,reviewing the incidence of colorectal polyps,age,location,size,shape,and the pathological type of carcinogenesis factors.Result: Colon polyp detection rate was 22.72%,carcinogenesis rate was 5.64%;A significant difference of different age groups are detected(X2= 8.250,P = 0.016),with a high detection of middle-aged patients.Colorectal polyps occurred in common in the rectum(32.00%) and sigmoid colon(35.80%),with polyp diameter ≤ 1cm(78.90%).Adenomatous polyps was the highest proportion in the diameter of 1cm-2cm polyps(70.12%).Morphological studies found non-lobulated polyps were more common(80.04%).It was found in carcinogenesis factors that elderly patients(X2= 10.070 P = 0.002),occurrence in the rectum and sigmoid colon(X2= 0.843 P = 0.016),polyp diameter> 2cm(X2= 114.173,P <0.001),lobulated polyps(X2= 16.66,P <0.001),adenomatous polyposis coli(X2= 71.14 p = <0.001) increased carcinogenesis rate significantly compared with other factors.Conclusion: The incidence of colorectal polyps are closely related to the age and sex;Different pathological types of colorectal polyps had significantly different clinical features;Occurrence in the rectum and sigmoid colon,non-lobulated,adenomatous polyposis coli diameter> 2.0cm are risk factors of carcinogenesis;Colorectal polyps is timely to treat,regular follow-up and therefore reducing the incidence of colorectal cancer.