摘要
目的:了解大肠息肉的临床表现,探讨息肉的恶变特征.方法:对6 144例有下消化道症状患者进行结肠镜检查,记录大肠息肉患者的临床表现以及年龄、性别等资料,对大肠息肉的发生率、内镜下表现、病理类型进行分析.结果:发现结肠息肉患者1 884例,检出率30.66%.男性占61.68%,女性占38.32%.年龄＞60岁者占64.12%.临床症状中便血占56.26%.息肉直径0.2～3.8 cm不等,恶变和重度不典型增生息肉直径＞2cm者占79.73%.息肉发生于左半结肠者占67.41%.癌变和重度不典型增生息肉发生于左半结肠占85.42%(375/439).病理类型:腺瘤性息肉42.00%,炎性息肉38.30%,错构瘤性息肉5.92%,增生性息肉6.45%,幼年性息肉7.40%.炎性息肉2例(2枚)癌变.腺瘤伴轻至中度不典型增生460枚占15.98%,重度不典型增生106枚占5.56%,癌变279枚占9.69%.腺瘤性息肉中管状腺瘤占37.46%(1 078/2 878),绒毛状腺瘤31.51%(907/2 878),混合性腺瘤31.03%(893/2 878).重度不典型增生和癌变率在上述三种腺瘤中分别为6.68%(72/1 078)、24.15%(219/907)和16.57%(148/893).结论:肠息肉临床症状以便血最多.多见于＞60岁的男性.息肉分布于左半结肠者多见,癌变息肉和重度不典型增生息肉也易发生于左半结肠,癌变和重度不典型增生多发生于腺瘤性息肉.管状腺瘤发生重度不典型增生和癌变率最低,绒毛状腺瘤最高.
OBJECTIVE： To review the clinical manifestations and study the characteristics of malignant transformation in colorectal polyps. METHODS： Colonoscopy was performed in 6144 individuals who had lower bowel symptoms. Data regarding to sex, age, and clinical symptoms were recorded for patients with colorectal polyps. The incidence, colonoscopy findings and histopathological lesion of colorectal polyps were evaluated. RESULTS： Colorectal polyps were diagnosed in 30. 66% （1 884/6 188） of patients （male 61.68% and female 38. 32 %） and more frequent （64. 12% ） in individuals over 60 yrs. Gastrointestinal bleeding occurred in 56.26% cases. The diameters of polyps ranged from 0. 2 to 3. 8 cm and 79. 73% cases were more than 2 cm with malignant and high-grade dysplasia phenotype. Polyps on the left colon were identified in 67. 41% individuals and of which 85.42% （375/439） were malignant or high-grade dysplasia. Histopathological lesion for polyp biopsies were classified as follows： adenomatous polyp （42.00%）, inflammatory （38. 30%）, pseudopolyp （5.92%）, hyperplastic polyp （6. 45%）, and juvenile polyp （7. 40%）. Two inflammatory polyps were found to be malignant. Among adenomatous polyps, low- and medium-grade dysplasia were present in 15.98% （460/2 878）, high-grade dysplasia in 5.56% （160/2 878） and cancerous in 9. 69%（279/2 878） cases. CONCLUSIONS： Colorectal polyps can be identified with colonoscopy with high yield. Gastrointestinal bleeding is a major symptom of colorectal polyps. They are frequently observed on left colon; more often in men than in women, appearing frequently in individuals over 60 yrs. Malignant and high-grade dysplastic polyps are often found on left colon; often greater than 2 cm in diameter, associated with blood effusion, fresh bleeding, bloody scar, and ulcer. Tubular polyps have the lowest rate of malignant transformation whereas villous polyps the highest.
出处
《肿瘤防治杂志》
2005年第24期1888-1890,共3页
China Journal of Cancer Prevention and Treatment
关键词
结肠镜
大肠息肉
不典型增生
癌
colonoscopy
colorectal polyp, dysplasia
cancer
