大肠息肉癌变因素的初步研究

目的研究大肠息肉癌变过程中的相关因素,总结高危性腺瘤的内镜及临床病理特点。方法回顾性分析研究266例大肠息肉的内镜下表现,临床病理特点及癌变的相关因素,对部分患者进行了内镜下治疗及随访。结果266例大肠息肉中,增生性息肉38例、炎性息肉64例,均未发现癌变病例,腺瘤性息肉164例,其中癌变21例,直径1.1-2.0cm及〉2.0cm的腺瘤癌变率高于直径≤1.0cm的腺瘤（P〈0.05）,绒毛状腺瘤的癌变率高于混合性腺瘤（P〈0.05）及管状腺瘤（P〈0.05）,颗数≥3的腺瘤癌变率高于1颗及2颗的腺瘤（P〈0.05）,有蒂腺瘤、亚蒂腺瘤及无蒂腺瘤的癌变率差异无统计学意义（P〉0.05）。结论直径〉1.0cm的腺瘤、绒毛状腺瘤和颗数≥3的腺瘤为高危性腺瘤,应加强对此类患者的内镜下治疗及随访,直径≤1.0cm腺瘤、管状腺瘤、1颗及2颗的腺瘤为低危性腺瘤,可根据肠镜检查结果进行随访,增生性息肉、炎性息肉可不常规随访。

An initial study of canceration factors for colorectal polyp

Objective Give a research to the canceration factors for colorectal polyps. To investigate the colonoscopy and clincopathological characteristics of dangerous adenomas. Methods The colonoscopy clincopathological characteristics and canceration factors for 266 cases of colorectal polyp were analyzed retrospectively. Part of the patients were followed. Results Of the 266 cases, 38 cases were proliferative polyp, 64 cases were inflammatory polyp, none of them cancerated, 164 cases were adenoma, among the adenomas, 21 cases were cancerated, there was a higher canceration rate for the big ones with diameter 1.1~2.0 cm and >2.0 cm than the small ones with diameter ≤1.0 cm(P<0.05),the canceration rate of villous adenoma was higher than tubular-villous adenoma (P<0.05) and tubular adenoma (P<0.05). There was a higher canceration rate for the number ≥3 than that of 1 and 2(P<0.05). The canceration rate between adenomas of long base short base and no base have no difference. Conclusion The adenomas with diameter>1.0 cm villous adenoma and that of the number≥3 were dangerous adenoma, we should treat and follow them seriously. The adenomas with diameter ≤1.0 cm tubular and with the number 1~2 ones were lower dangerous adenoma, we may follow them for the endoscopic detection. Proliferative polyp and inflammatory polyp may not be followed as usual.