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.

The clinical analysis of post-polypectomy follow-up and colonoscopic surveillance in 233 colorectal adenoma cases

Objective To investigate recurrence of colorectal adenoma (CRA) after polypectomies and colonoscopic surveillance,and to explore risk factors related to CRA recurrence.Methods From June 2005 to December 2009,in the Fist Affiliated Hospital of Anhui Medical University,the clinical data of 283 hospitalized patients who underwent CRA polypectomy and met the study criteria were collected and followed up.The recurrence rate of CRA after polypectomies,the relationship between colonoscopic surveillance interval and CRA recurrence and risk factors related to recurrence were analyzed.The colonoscopic surveillance interval,frequency and the reason for no colonoscopic surveillance were also analyzed.Results A total of 235 post-polypectomies CRA patients were successfully followed up,the follow-up rate was 83.0％ (235/283).The shortest follow-up period was 12 months and the longest was 66 months,the median follow-up time was (35.1 ± 14.2)months.A total of 115 patients were underwent colonoscopic surveillances,the surveillance rate was 49.4％ (115/233).The recurrence rate was 45.0％ (50/111) in colonoscopic surveillance group.A total of 118 patients were without colonoscopic surveillances.Age over 60 years,body mass index over 25 kg/m2 and multiple adenomas (≥ 2) were significantly related with CRA recurrence,and the difference was statistical significant (P＜ 0.05).The rate of awareness that CRA needed regular surveillance group without surveillonce was significantly lower than that of group with surveillance.(P＜0.01).Conclusion The recurrence rate of CRA after polypectomies is high.Age,high body mass index and multiple adenomas are predicted independent risk factors for CRA recurrence.Lacking awareness of the importance of regular surveillances after polypectomies is the main reason for low colonoscopic surveillance rate after polypectomies in our hospital.