中华消化杂志
中華消化雜誌
중화소화잡지
Chinese Journal of Digestion
2015年
4期
231-234
,共4页
崔凝%罗和生%刘军%陈炜%全晓静
崔凝%囉和生%劉軍%陳煒%全曉靜
최응%라화생%류군%진위%전효정
哨兵息肉%直肠息肉%结肠肿瘤%结肠镜
哨兵息肉%直腸息肉%結腸腫瘤%結腸鏡
초병식육%직장식육%결장종류%결장경
Sentinel polyp%Rectal polyp%Colonic neoplasms%Colonoscopes
目的 探讨哨兵息肉(即直肠息肉并发近端结肠癌)患者的临床特点及哨兵息肉与近端结肠癌的相关性.方法 回顾性分析2003年1月至2013年12月963例因直肠息肉住院患者的病例资料.按是否并发近端结肠癌将患者分为哨兵息肉组(108例)和单纯直肠息肉组(855例),观察两组内镜下特点、临床病理学特征、治疗与转归情况等,组间差异采用卡方检验进行比较.结果 963例患者总住院时间为4～33 d,平均年龄为(49.7±9.4)岁,以男性(610例,63.3％)居多.785例患者(81.5％)有排便次数/习惯改变、便血、腹痛、腹胀等非特异性下腹部症状.78例(8.1％)患者有三代血缘内的亲属确诊患肿瘤,亦有部分患者亲属确诊为家族性腺瘤性息肉病(2.2％,21/963).哨兵息肉组的肿瘤标志物阳性率(69.4％,75/108)较单纯息肉组高(6.8％,58/855;x2=316.285,P＜0.01).哨兵息肉患者内镜下近端结肠癌多表现为新生物样环绕管腔生长,但在发现远端直肠息肉直到进镜至近端结肠癌间的肠管并无特殊表现.哨兵息肉组与单纯直肠息肉组相比,哨兵息肉组最大径＞l cm的息肉、多发性息肉(息肉数＞5枚)、腺瘤性息肉多见[61.1％(66/108)比46.9％(401/855),38.9％(42/108)比11.8％(101/855),83.3％(90/108)比35.6％(304/855),x2=7.752、55.595、90.544,P均＜0.01].哨兵息肉伴发的近端结肠癌以乳头状腺癌和管状腺癌多见,共占75.9％(82/108),亦可见黏液癌及印戒细胞癌等.59.3％(64/108)的伴发结肠恶性肿瘤未穿透浆膜层(即Duke A期和B期),已有远处脏器转移者(即Duke D期)较少(19/108,17.6％).95.6％(817/855)的单纯直肠息肉患者接受了内镜治疗,均痊愈出院;哨兵息肉组中41.7％(45/108)接受外科根治手术,19.4％(21/108)接受内镜黏膜下剥离术.结论 结肠镜检查发现直肠多发的、最大径＞1 cm和腺瘤性息肉时,应警惕息肉自身及近端肠管的癌变可能,即使患者进镜困难或无法耐受全结肠检查,也应在短期内复查随访,完成全结肠检查.
目的 探討哨兵息肉(即直腸息肉併髮近耑結腸癌)患者的臨床特點及哨兵息肉與近耑結腸癌的相關性.方法 迴顧性分析2003年1月至2013年12月963例因直腸息肉住院患者的病例資料.按是否併髮近耑結腸癌將患者分為哨兵息肉組(108例)和單純直腸息肉組(855例),觀察兩組內鏡下特點、臨床病理學特徵、治療與轉歸情況等,組間差異採用卡方檢驗進行比較.結果 963例患者總住院時間為4～33 d,平均年齡為(49.7±9.4)歲,以男性(610例,63.3％)居多.785例患者(81.5％)有排便次數/習慣改變、便血、腹痛、腹脹等非特異性下腹部癥狀.78例(8.1％)患者有三代血緣內的親屬確診患腫瘤,亦有部分患者親屬確診為傢族性腺瘤性息肉病(2.2％,21/963).哨兵息肉組的腫瘤標誌物暘性率(69.4％,75/108)較單純息肉組高(6.8％,58/855;x2=316.285,P＜0.01).哨兵息肉患者內鏡下近耑結腸癌多錶現為新生物樣環繞管腔生長,但在髮現遠耑直腸息肉直到進鏡至近耑結腸癌間的腸管併無特殊錶現.哨兵息肉組與單純直腸息肉組相比,哨兵息肉組最大徑＞l cm的息肉、多髮性息肉(息肉數＞5枚)、腺瘤性息肉多見[61.1％(66/108)比46.9％(401/855),38.9％(42/108)比11.8％(101/855),83.3％(90/108)比35.6％(304/855),x2=7.752、55.595、90.544,P均＜0.01].哨兵息肉伴髮的近耑結腸癌以乳頭狀腺癌和管狀腺癌多見,共佔75.9％(82/108),亦可見黏液癌及印戒細胞癌等.59.3％(64/108)的伴髮結腸噁性腫瘤未穿透漿膜層(即Duke A期和B期),已有遠處髒器轉移者(即Duke D期)較少(19/108,17.6％).95.6％(817/855)的單純直腸息肉患者接受瞭內鏡治療,均痊愈齣院;哨兵息肉組中41.7％(45/108)接受外科根治手術,19.4％(21/108)接受內鏡黏膜下剝離術.結論 結腸鏡檢查髮現直腸多髮的、最大徑＞1 cm和腺瘤性息肉時,應警惕息肉自身及近耑腸管的癌變可能,即使患者進鏡睏難或無法耐受全結腸檢查,也應在短期內複查隨訪,完成全結腸檢查.
목적 탐토초병식육(즉직장식육병발근단결장암)환자적림상특점급초병식육여근단결장암적상관성.방법 회고성분석2003년1월지2013년12월963례인직장식육주원환자적병례자료.안시부병발근단결장암장환자분위초병식육조(108례)화단순직장식육조(855례),관찰량조내경하특점、림상병이학특정、치료여전귀정황등,조간차이채용잡방검험진행비교.결과 963례환자총주원시간위4～33 d,평균년령위(49.7±9.4)세,이남성(610례,63.3％)거다.785례환자(81.5％)유배편차수/습관개변、편혈、복통、복창등비특이성하복부증상.78례(8.1％)환자유삼대혈연내적친속학진환종류,역유부분환자친속학진위가족성선류성식육병(2.2％,21/963).초병식육조적종류표지물양성솔(69.4％,75/108)교단순식육조고(6.8％,58/855;x2=316.285,P＜0.01).초병식육환자내경하근단결장암다표현위신생물양배요관강생장,단재발현원단직장식육직도진경지근단결장암간적장관병무특수표현.초병식육조여단순직장식육조상비,초병식육조최대경＞l cm적식육、다발성식육(식육수＞5매)、선류성식육다견[61.1％(66/108)비46.9％(401/855),38.9％(42/108)비11.8％(101/855),83.3％(90/108)비35.6％(304/855),x2=7.752、55.595、90.544,P균＜0.01].초병식육반발적근단결장암이유두상선암화관상선암다견,공점75.9％(82/108),역가견점액암급인계세포암등.59.3％(64/108)적반발결장악성종류미천투장막층(즉Duke A기화B기),이유원처장기전이자(즉Duke D기)교소(19/108,17.6％).95.6％(817/855)적단순직장식육환자접수료내경치료,균전유출원;초병식육조중41.7％(45/108)접수외과근치수술,19.4％(21/108)접수내경점막하박리술.결론 결장경검사발현직장다발적、최대경＞1 cm화선류성식육시,응경척식육자신급근단장관적암변가능,즉사환자진경곤난혹무법내수전결장검사,야응재단기내복사수방,완성전결장검사.
Objective To explore the clinical features of sentinel polyps (rectal polyps with proximal colon carcinoma) and its correlation with proximal colon carcinoma.Methods From January 2003 to December 2013,the clinical features of 963 hospitalized patients with rectal polyps were retrospectively analyzed.According to whether the patient with colon carcinoma,the clinical data of rectal polyps patients were divided into pure polyps group (n=855) and sentinel polyps group (n 108).The characteristics under endoscopy,clinical pathological features,treatment and prognosis of the two groups were observed.Chi square test was performed for differences comparison between groups.Results The length of stay in hospital of 963 patients was from four to 33 days,the average age was (49.7 ± 9.4) years,and the majority of the patients were male (n=610,63.3％).A total of 785 patients (81.5％) had non-specific abdominal symptoms,such as frequency or habit change of defecation,hematochezia,abdominal pain,abdominal distension.The relatives within three generation of 78 patients (8.1 ％) were diagnosed with tumor and some relatives of the patients diagnosed with familial adenomatous polyposis (2.2％,21/963).The positive rate of tumor marker of sentinel polyps group was higher (69.4％,75/ 108) than that of pure polyps group (6.8％,58/855; x2 =316.285,P＜0.01).The proximal colon carcinoma of patients with sentinel polyps appeared as neoplasma with circumferential growth,there was no specific appearance between distal rectal polyps and proximal colon carcinoma.When compared with pure polyps group,most polyps of sentinel polyps group were in maximum diameter over 1 cm (61.1％ (66/108) vs 46.9％ (401/855)),multi polyps (n＞5,38.9％ (42/108) vs 11.8％ (101/855)) and adenomatous polyp (83.3％ (90/108) vs 35.6％(304/855),x2=7.752,55.595 and 90.544,all P＜ 0.01).Majority of the proximal colon carcinoma with rectal polyps was papillary adenocarcinoma and tubular adenocarcinoma which was account for 75.9％ (82/108).Some were mucinous carcinoma and signet ring cell carcinoma.Most of the proximal colon carcinoma with rectal polys did not penetrate the serosa layer (Duk A-+Duk B,59.3％,64/108) and with little distant metastasis (Duke D,17.6％,19/ 108).Ninty-five point six percent (817/855) of patients with pure polyps underwent endoscopic treatment and all of them were cured and discharged.Forty-one point seven percent (45/108) of patients of sentinel polyps group accepted the radical operation and 19.4％ (21/108) received endoscopic submucosal dissection.Conclusions If multiple,maximum diameter over 1 cm and adenomatous rectal polyps were detected under colon endoscope,the possibility of carcinogenesis of the polyps or the proximal colon should be awared.If the endoscope is difficult to go further or the patient can not tolerate the whole colon examination,the patient should be followed up in short-term and complete the whole colon examination.
