摘要
目的：分析哨兵息肉（直肠息肉并发近端结肠癌）患者临床特征以及哨兵息肉和近端结肠癌的相关性。方法回顾性分析331例直肠息肉患者的临床资料，按是否并发近端结肠癌分为哨兵息肉组（观察组，37例）和单纯直肠息肉组（对照组，294例），比较两组患者的家族史、实验室检查、结肠镜检查、病理检查、治疗方法、转归以及短期内预后情况。结果观察组家族史率、肿瘤标志物异常率及息肉最大径＆gt;1 cm、息肉＆gt;5枚、腺瘤性息肉发生率明显高于对照组[35.1%（13/37）比4.8%（14/294）、67.6%（25/37）比6.8%（20/294）、62.2%（23/37）比46.6%（137/294）、43.2%（16/37）比11.9%（35/294）、83.8%（31/37）比35.4%（104/294）]，差异有统计学意义（P＜0.01）。对照组患者结肠镜检查无特殊发现；观察组近端结肠癌患者的结肠镜下表现多为新生物环绕着管腔进行性生长，但远端直肠息肉与近端结肠癌间正常肠管没有特殊发现。观察组结肠癌患者病理类型以乳头状腺癌和管状腺癌为主，占75.7%（28/37）。Duke分期：A期11例（29.7%，11/37），B期11例（29.7%，11/37），C 期9例（24.3%，9/37），D 期6例（16.2%，6/37）。对照组282例（95.9%，282/294）采用内镜下治疗，均全部治愈出院；观察组15例（40.5%，15/37）采用根治术治疗，9例（24.3％，9/37）采用内镜下治疗，7例（18.9%，7/37）采用外科姑息性手术，4例（10.8%，4/37）采用化疗治疗，2例（5.4%，2/37）采用内科对症治疗；随访6～12个月，23例肿瘤完全切除患者未见复发，12例肿瘤缩小或症状减轻，另2例死亡。结论如直肠存在最大径＆gt;1 cm、多发性及腺瘤性息肉时，需警惕息肉本身以及近端结肠发生癌变的可能，应在短期内对患者随访并进行全结肠检查。
Objective To explore the clinical features of sentinel polyps （rectal polyps with proximal colon carcinoma）, and the correlation between sentinel polyps and proximal colon carcinoma. Methods The clinical data of 331 patients with rectal polyps were retrospectively analyzed. According to the combination condition of proximal colon carcinoma, the patients were divided into sentinel polyps group （observation group, 37 cases） and pure rectal polyps group （control group, 294 cases）. The family history, laboratory examination, colonoscopy, clinical pathological features, treatment, sequelae and short-term prognosis were compared between 2 groups. Results The family history rate, positive rate of tumor marker and the incidences of polyps maximum diameter＆gt;1 cm, polyps＆gt;5 pieces, adenomatous polyp in observation group were significantly higher than those in control group：35.1%（13/37） vs. 4.8%（14/294）, 67.6%（25/37） vs. 6.8%（20/294）, 62.2%（23/37） vs. 46.6%（137/294）, 43.2%（16/37） vs. 11.9%（35/294） and 83.8%（31/37） vs. 35.4%（104/294）, and there were statistical differences （P〈0.01）. The patients in control group did not have special find in colonoscopy. The majority patients in observation group had new organisms around the lumen growth in colonoscopy, but the intestinal canal between rectal polyps and proximal colon carcinoma did not have special find. The majority pathologic type of proximal colon carcinoma patients in observation group was papillary adenoearcinoma and tubular adenocarcinoma, 75.7%（28/37）. Duke stage：A stage was in 11 cases （29.7%, 11/37）, B stage in 11 cases （29.7%, 11/37）, C stage in 9 cases （24.3%, 9/37）, and D stage in 6 cases （16.2%, 6/37）. In control group, 282 patients （95.9%, 282/294） were treated by endoscope, and they were cured and discharged. In observation group, 15 patients （40.5%, 15/37） were treated with radical operation, 9 patients （24.3%, 9/37） by endoscope, 7 patients （18.9%, 7/37）
出处
《中国医师进修杂志》
2016年第8期697-700,共4页
Chinese Journal of Postgraduates of Medicine
关键词
息肉
结肠肿瘤
结肠镜检查
回顾性研究
Polyps
Colonic neoplasms
Colonoscopy
Retrospective studies
