舒林酸对家族性腺瘤性息肉病结直肠残存腺瘤组织病理学表现的影响

目的:观察长期服用舒林酸的家族性腺瘤性息肉病(FAP)患者结直肠中残存腺瘤的组织病理学表现,初步探讨舒林酸对FAP患者残存腺瘤的影响.方法:FAP患者口服舒林酸400 mg/d,12个月内每3个月复查一次,观察结直肠息肉的变化.以后根据患者结肠腺瘤消退情况决定是否继续服用舒林酸维持治疗,并定期复查结肠镜,对残存息肉及其他病变进行活检,并进行病理检查.结果:舒林酸治疗前FAP患者结直肠腺瘤活检标本中,管状腺瘤占活检腺瘤总数的90.8%,绒毛管状腺瘤占9.2%;异型程度为Ⅰ级、Ⅱ级、Ⅲ级的腺瘤分别占42.1%,45.6%和12.3%.治疗后管状腺瘤占活检腺瘤总数的99.8%,绒毛管状腺瘤占0.2%;异型程度为Ⅰ级、Ⅱ级、Ⅲ级的腺瘤分别占55.8%,41.8%和2.4%,与治疗前相比差异有统计学意义(P＜0.01).治疗期间肠道中出现微小扁平隆起和红斑,其中约65%为腺瘤.结论:舒林酸长期维持治疗可使家族性腺瘤性息肉病患者结直肠残存腺瘤异型程度下降,绒毛管状腺瘤减少,而微小扁平隆起和红斑可能是腺瘤消退过程中的表现.

The effects of sulindac on the pathology of colorectal remnant polyps of familial adenomatous polyposis (FAP) patients

OBJECTIVE: To evaluate the long-term effectiveness of sulindac on the pathology of colorectal adenomas of familial adenomatous polyposis (FAP) patients. METHODS: FAP patients were treated with sulindac 400 mg per day. The change of colorectal polyps was assessed every 3 months in the first year. After the significant regression of colorectal polyps was achieved, sulindac was used to maintain the effects. The patients received colonoscopy examination regularly. Biopsies of remnant polyps and other lesions were obtained. The type and dysplasia grade of biopsies were evaluated and compared with baseline. RESULTS: Before the study, 90.8% of adenoma biopsies were tubular, while 9.2% was tubulovillous adenoma. The dysplasia of grades I, II and III were 42.1%, 45.6% and 12.3%, respectively. After sulindac treatment, 99.8% of adenoma biopsies were tubular, while 0.2% tubulovillous adenoma. There was significant difference compared with baseline (P<0.01). The dysplasia of grades I, II and III were 55.8%, 41.8% and 2.4% respectively, which had significant difference with baseline (P<0.01). Minor flat elevation and erythema were found during the treatment, in which approximately 65% was adenoma. CONCLUSION: Long-term use of sulindac seems to be effective in reducing dysplasia grade and tubulovillous adenoma of retained colorectal adenoma of FAP patients. Minor flat elevation and erythema may be the lesions appearing during the regression of adenoma.