老年人大肠息肉的临床分析

目的 探讨老年人大肠息肉的临床特点及其与癌变的关系。方法 对我院经结肠镜检出的158例老年大肠息肉患者的临床特点进行回顾性分析，对其中120例进行1－6年（平均4．5年）的结肠镜随访，并与青中年组的437例患者相对照。结果 老年人大肠息肉的检出率、癌变率分别为30．0％及23．4％，均显著高于中青年组的10．2％及6．9％（P＜0．01），随年龄增长检出率有逐渐增加的趋势。分布以直肠和乙状结肠多见，但升结肠的癌变率（37．5％）明显高于左半结肠（14．3％，P＜0．05），且直肠、降结肠、横结肠及升结肠的癌变率也显著高于青中年组的同一部位（P＜0．01）；病理类型以腺瘤性息肉为多，占77．6％，也明显高于青中年组的同一病理类型（P＜0．01）。37例癌变息肉均为腺瘤性息肉，其中绒毛状腺瘤的癌变率（56．9％）显著高于管状腺瘤（3．4％，P＜0．01）。息肉体积大（＞2cm)、基底宽、数量多，癌变率高。腺瘤性息肉经内镜下摘除者其癌变率明显低于未摘除者（P＜0．01）。结论 老年人大肠息肉中的腺瘤性息肉的大小、形态、数量及病理类型是其癌变的主要危险因素，老年人应尽量行全结肠检查，检出大肠息肉者应尽可能首选肠镜下摘除，定期随访，减少癌变的机会。

Clinic analysis on colonic polyps of elderly people

Objective This study was designed to understand the characteristics of colonic polyps in aged people, and the relationship between the colonic polyps and the malignant change. Methods A total of 158 patients with colonic polyps diagnosed by endoscopy were retrospectively analyzed during the recent years. Among them, 120 patients had been followed up by endoscopy for 1 to 6 years(average 4 5 years) and were compared with 437 young patients. Results The detective rate and the malignant change rate of colonic polyps in the aged people were 30% and 23 4%, respectively, being significantly higher than that of the young (10 2%) and the middle aged people(6 9%, P <0 01), and the detected rate showed gradually increasing trend with the increases of age. The colonic polyps in elderly people usually occur in rectum and sigmoid colon, but those polyp with malignancy distributed in ascending colon are significantly higher than those in left side colon (37 5% vs 14 3%, P <0 01). Theoe polyps in rectum, descending colon, transverse colon and ascending colon in the elderly group seemed easily going malignancy than those at the same locations in young and middle aged groups. The colonic polyps in the aged group were predominantly adenomatous polyps(77 6%), being significantly higher than that in the young group ( P <0 01). All of the 37 cases with malignant change are adenomatous. The frequency of malignant villous adenoma was significantly higher than that of the tubular adenoma(56.9% vs 3.8%, P <0 01). The larger in size and the broader in fundus and the more in number, the higher frequency of malignancy the polyps. Conclusions In the elderly patinets with clonic polyps, the size, morphology, numbers and pathological types of ademafous changes are most significant risk factors for malignant change.Elderly people with the positive detection should be examined by endoscopy for all colon and be followed-up periodically in order to prevent them from malignant transformation.