摘要
目的随访嘉定地区2年内结肠直肠息肉临床特点及内镜下治疗后的改变,以期更好地指导今后的临床及科研工作。方法收集2年间上海交通大学医学院附属瑞金医院北院就诊的结肠镜检查结肠直肠息肉性疾病治疗前后患者的临床资料,根据基本信息,包括性别、年龄、发病时的症状、结肠镜检查结果及后续其他检查手段,分析病情的变化并进行统计学分析。结果结肠直肠息肉需经内镜治疗1 265例,男776例,女489例,临床表现为无症状(10.1%)、血便/黑便/粪隐血阳性(27.8%)、腹痛(10.7%)、腹泻(22.0%)及其他(29.4%)。以远端结肠(直肠、乙状结肠)分布为主(49.7%),多息肉患者占25.0%。青年组581例(45.9%),老年组684例(54.1%)。老年和青年组内息肉的病理类型、形态学、大小中以管状腺瘤、山田Ⅰ型、<1.0 cm发病率最高,组内比较,差异有统计学意义(P<0.05);而老年组及青年组组间比较,差异无统计学意义(P>0.05)。1 265例患者内镜下治疗中热活检钳除52例,APC电凝581例,EMR模式切除622例,ESD模式切除10例。均成功切除息肉,无死亡病例。并发症主要表现为:腹痛45例,出血36例,肠穿孔2例,发热4例。术前及术后息肉病理学比对一致率为85.6%。随访时间为1年,再发现率为39.9%。结论上海市嘉定地区结肠直肠息肉处于高发病率状态,注重肠镜筛查尤为重要。在内镜下的治疗中,注意多种手术方式的有机结合,注重疾病的长期随访和治疗,对预防疾病的复发尤为关键。
Objective To observe the relevant factors of colorectal polyps and the following up of endoscopic polypectomy in Jiading district of Shanghai during 2 years, for further diagnosis and treatment of clinical and basic studies. Methods All of 1 265 patients were enrolled from Jan. 2013 to Feb. 2014, data including gender, age, symptoms, changes observed during colonoscopy and results of pathology examination were collected. Clinical features and endo- scopic polyp size, morphology, surgical method and complication rate were analyzed. Results Of 1 265 patients, 776 were male, 489 were female, which were treated by endoscopic polypectomy. No symptom （10. 1% ） , abdominal pain （ 10.7% ）, diarrhea （22.0%）, bloody stools （27.8%） and other discomforts such as constipation and change of character of stool （29.4%） were also the main initial symptoms of the colorectal polyps. For the subjects, 25.0% were diagnosed as polyps, and 49.7% of the lesions located at rectum or sigmoid colon. The polyp number, location （left colon polyps） , morphology （Yamada I） , pathological types （tubular gland tumor） were showed difference in elderly group or young group, but showed no difference between two groups. For all of this patients, 52 were treated by hot biopsy forceps, 581 were treated by APC, 622 were treated by EMR, 10 were treated by ESD. The total complication of endoscopic polypectomy included abdominal pain （ n = 45 ） , bloody stools （ n = 36） , intestinal perforation （ n = 2） and fever （n = 4）. A consistency rate （85.6%） of pathological diagnosis existed between endoscopic biopsy and resection, fol- low-up for 1 year time, and found polyps at a rate of 39.9%. Conclusion The detection rate of colorectal polyps in Jiading distract of Shanghai is high. The colonoscopy is an effective screening approach for early detection of colorectal polyps. The clinical characteristic is different in patients, a targeted endoscopic treatment method should be chosen by clinicians. And it is imp
出处
《胃肠病学和肝病学杂志》
CAS
2016年第5期524-528,共5页
Chinese Journal of Gastroenterology and Hepatology
