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 1 2 9例老年大肠息肉患者的临床特点进行回顾性分析 ,并与青中年组的 3 5 0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 2 9.9%及 2 3 .3 %,均显著高于中青年组的 1 0 .0 %及 7.4 %(P<0 .0 1 ) ,随年龄增长检出率有逐渐增加的趋势。主要临床表现为便秘。分布以左半结肠多见 ,但升结肠的癌变率明显高于其他结肠段 (P <0 .0 5 ) ,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 .0 1 )。病理类型以腺瘤性息肉为多 ,占 76.4 %,也明显高于青中年组的同一病理类型 (P <0 .0 1 )。 3 0例癌变息肉均为腺瘤性息肉 ,其中绒毛状腺瘤的癌变率 (5 7.4 %)显著高于管状腺瘤 (3 .2 %,P <0 .0 1 )。息肉体积大 (>2cm)、基底宽、数量多 ,癌变率高。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 ,不管大小完整切除 ,定期随访 ,减少癌变的机会。

Clinical analysis of colonic polyps in aged people

Objective : This study was designed to evaluate the characteristic of colonic polyps in aged people, and the relationship between the colonic polyps and the malignant change. Method: A total of 129 patients with colonic polyps diagnosed by endoscopy were retrospectively analyzed during the recent years, and were compared with 350 young and middle-aged patients. Result: The detective rate and the malignant change rate of colonic polyps in the aged people were 29.9% and 23.3%, respectively, being significantly higher than that of the young and middle-aged people(10.0% and 7.4%,P<0.01), and the detected rate showed gradually increasing trend with the increases of age. Constipation was the most common clinical symptom. The colonic polyps in aged people usually occur in left hemicolon, but those polyps with malignancy distributed in ascending colon were significantly higher than the other colonic sections(P<0.05).Those polyps in rectum,descending colon,transverse colon and ascending colon in the aged group seemed easily going malignancy than those at the same locations in young and middle-age groups. The colonic polyps in the aged group were predominantly adenomatous polyps(76.4%),being significantly higher than that in the young and middle-age groups (P<0.01).All of the 30 cases with malignant change were adenomatous. The frequency of malignant villous adenoma was significantly higher than that of the tubular adenoma(57.4Vs3.2%,P<0.01). The larger in size and the broader in fundus and the more in number, the higher frequency of malignancy the polyps. Conclusion : In the aged patients with colonic polyps, the size, morphology, numbers and pathologicl types of adenomatous changes are most significant risk factors for malignant change. Aged people should be examined by endoscopy for all colon and extirpated colonic polyps regardless of size, and be followed-up periodically in order to prevent them from malignant transformation.