大肠平坦型腺瘤与隆起型腺瘤的临床特征比较

目的 探讨大肠平坦型腺瘤的发病情况，比较平坦型腺瘤与隆起型腺瘤的临床特征和镜下特点。方法设定一个时间段选择我院连续行结肠镜检查的患者，经肠镜下切除的并经病理证实为腺瘤的所有病变，收集完整的一般临床资料，根据镜下肉眼形态分为平坦型腺瘤和隆起型腺瘤，计算平坦型腺瘤在结肠镜检查人群中的检出率，应用构成比计算平坦型腺瘤占检出腺瘤的比例，比较平坦型腺瘤和隆起型腺瘤的临床特征和镜下特点，包括患者性别、年龄、病变大小和部位。结果结肠镜检查共10319例，符合纳入标准的共468例患者，550枚息肉，其中检出30例31枚息肉为平坦型腺瘤，438例519枚息肉为隆起型腺瘤，平坦型腺瘤在结肠镜检查人群中的检出率为0．29％，占检出腺瘤的6．41％；平坦型腺瘤和隆起型腺瘤的性别、年龄、大小和单发腺瘤／多发腺瘤的比率差异均无显著性；平坦型腺瘤有41．94％位于右半结肠，而隆起型腺瘤仅24．47％，差异有盟著性。结论平坦型腺瘤在国内并非罕见，平坦型腺瘤较隆起型腺瘤倾向发生于右半结肠，提示全大肠镜检查更有利于检出平坦型腺瘤。

The comparison of clinical features of fiat and polypoid colorectal adenomas

Objective To investigate the incidence of fiat colorectal adenomas in outpatients and inpatients who had undergone eoloscopy and to study the differences of clinical and endoscopic features of flat and polypoid coloreetal adenomas. Methods All the examples of coloscopy were analyzed and all the adenoma lesions, which were resected under colonoscope and confirmed by histopathology in a retrospective study, were reviewed during a consecutive period in Huizhou municipal central hospital. The patients general clinical data and the lesions pathologic data were collected. The lesions were classified into fiat and polypoid adenomas based on the macroscopic apperarances under endoscope. Evaluations include the detection rate and the distribution of flat adenomas in all the detectable adenomas, comparing the general clinical and pathologic features of flat and polypoid adenomas such as gender, age, size and site. Results A total of 10 319 patients underwent colocopy in which 468 patients and 550 polyps were eligible for this study, of which 30 patients and 31 polyps were flat adenomas, 438 patients and 519 polyps were polypoid adenomas. The detection rate of flat adenomas in patients undergoing eolocopy was 0.29% and the proportion of flat adenomas in all detectable adenomas was 6.41% （30/468）. Sex ratio, age, size and the rate of single adenomas and mutiply adenomas did not differ between flat and polypoid adenomas. 41.94% （13/31）of flat adenomas were found proximal to the splenic flexure versus 24.41% （127/519）of polypoid adenomas, which was statistically significant. Conclusion Flat adenomas are not uncommon in our country; fiat adenomas are more common in the right hemicolon compared with polypoid adenomas, indicating the importance of total coloscopy in flat adenomas detection.