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《中华消化外科杂志》2018年2月第17卷第2期论著

结直肠扁平息肉内镜黏膜切除术后的病理学分析

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引用本文:
阿布都萨拉木·阿布拉,热依拉·加帕尔,刘雪芳,等.结直肠扁平息肉内镜黏膜切除术后的病理学分析[J].中华消化外科杂志,2018,17(2):173-176.DOI:10.3760/cma.j.issn.1673-9752.2018.02.010.
【摘要】

目的:分析结直肠扁平息肉行内镜黏膜切除术(EMR)后的病理学类型,探讨发生高风险扁平腺瘤性息肉的危险因素。
方法:采用回顾性病例对照研究方法。收集2010年2月至2016年4月新疆维吾尔自治区人民医院收治的245例结直肠扁平息肉患者的临床病理资料。245例患者均行EMR治疗,切除息肉组织行病理学诊断。观察指标:(1)扁平息肉的临床特征及病理学检查结果。(2)高风险扁平腺瘤性息肉的危险因素分析。正态分布的计量资料采用±s表示。单因素分析采用X2检验,多因素分析采用Logistic回归分析。
结果:(1)扁平息肉的临床特征及病理学检查结果:245例患者扁平息肉部位:盲肠12例、升结肠26例、横结肠55例、降结肠35例、乙状结肠73例、直肠44例。245例患者中,153例伴多发息肉。245例患者扁平息肉直径为(0.9±0.8)cm。245例患者病理学检查结果:管状腺瘤低级别上皮内瘤变108例,管状绒毛状腺瘤低级别上皮内瘤变40例,管状绒毛状腺瘤高级别上皮内瘤变18例,管状腺瘤高级别上皮内瘤变25例,腺癌14例(分期均为T1期),神经内分泌肿瘤3例,锯齿状息肉12例,黏膜慢性炎12例,增生性息肉13例。(2)高风险扁平腺瘤性息肉的危险因素分析:单因素分析结果显示:年龄、息肉数目、息肉直径是发生高风险扁平腺瘤性息肉的相关因素(X2=8.920,5.455,36.901,P<0.05)。多因素分析结果显示:年龄>60岁、息肉直径>1 cm是发生高风险扁平腺瘤性息肉的独立危险因素[比值比(OR)=2.681,8.162,95%可信区间:1.481~4.856,3.786~17.597,P<0.05]。
结论:结直肠扁平息肉以腺瘤性息肉为主,年龄>60岁、息肉直径>1 cm是发生高风险扁平腺瘤性息肉的独立危险因素。

【Abstract】

Objective:To analyze the pathological types of colorectal flat polyps after endoscopic mucosal resection (EMR), and explore the risk factors of highrisk flat adenomatous polyps.
Methods:The retrospective casecontrol study was conducted. The clinicopathological data of 245 patients with colorectal flat polyps who were admitted to the People′s Hospital of Xinjiang Uygur Autonomous Region between February 2010 and April 2016 were collected. All the patients underwent EMR, and incision tissues were diagnosed by pathological examination. Observation indicators: (1) clinical features and results of pathological examination of flat polyps; (2) risk factors analysis of highrisk flat adenomatous polyps. Measurement data with normal distribution were represented as ±s. The univariate analysis and multivariate analysis were respectively done using the chisquare test and Logistic regression model.
Results:(1) Clinical features and results of pathological examination of flat polyps: flat polyps located in the cecum, ascending colon, transverse colon, descending colon, sigmoid colon and rectum were detected in 12, 26, 55, 35, 73 and 44 patients, respectively. Of 245 patients, 153 were combined with multiple polyps. The diameter of flat polyps was (0.9±0.8)cm. Results of pathological examination of 245 patients: 108, 40, 18, 25, 14, 3, 12, 12 and 13 patients were diagnosed with as tubular adenomas with lowgrade intraepithelial neoplasias (LGINs), tubulovillous adenomas with LGINs, tubulovillous adenomas with highgrade intraepithelial neoplasias (HGINs), tubular adenomas with HGINs, adenocarcinomas (T1 stage), neuroendocrine tumors, serrated polyps, mucosal chronic inflammation and hyperplastic polyps, respectively. (2) Risk factors analysis of highrisk flat adenomatous polyps: the results of univariate analysis showed that age, number and diameter of polyps were the related factors related factors affecting the occurrence of highrisk flat adenomatous polyps (X2=8.920, 5.455, 36.901, P<0.05). The results of multivariate analysis showed that age > 60 years old and diameter of polyps >1 cm were the independent risk factors affecting occurrence of highrisk flat adenomatous polyps (Odds ratio=2.681, 8.162, 95% confidence interval: 1.481-4.856, 3.786-17.597, P<0.05).
Conclusion:The main colorectal flat polyps are adenomatus polyps, and age > 60 years old and diameter of polyps > 1 cm are the independent risk factors affecting occurrence of highrisk flat adenomatous polyps.

DOI:10.3760/cma.j.issn.1673-9752.2018.02.010
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