【作者】 李建国；

【导师】 徐杨；

【作者基本信息】 中南大学 ， 消化内科， 2011， 硕士

【摘要】 目的分析结直肠腺瘤性息肉电切术后复发的危险因素。探讨腺瘤性息肉电切术后的最佳随访策略。方法对327例接受过结直肠腺瘤性息肉电切术后结肠镜随访的病例资料进行回顾性分析。各病例随访1～4次,随访间期4～95个月不等,记录患者首次全结肠镜检查时的年龄、性别、腺瘤大小、数目、病理分型及不典型增生程度,并观察其结肠镜复查时是否发现新的腺瘤或结直肠癌。分析腺瘤复发与首次结肠镜检查所发现腺瘤的临床特征的关系,探讨腺瘤复发的危险因素及腺瘤复发与随访间期的关系。结果对327例病例的多因素回归分析结果表明,腺瘤直径、数目、病理分型、不典型增生程度与腺瘤复发正相关；性别、年龄与腺瘤复发无关；腺瘤数目≥3个、直径≥1cm、中度或重度不典型增生、绒毛状腺瘤或混合性腺瘤属于高危病例,1或2个直径小于1cm的管状腺瘤且没有中或重度不典型增生的腺瘤属于低危病例；高危组病例累积复发危险显著高于低危组病例；高危组病例不同随访间期之间(3年以内,3～5年,5年以上)腺瘤复发率比较有显著性差异,低危组病例无显著性差异。结论结直肠腺瘤性息肉电切术后复发的危险因素包括息肉大小、数目、病理分型、不典型增生程度。电切术前腺瘤数目≥3个、腺瘤直径≥1cm、病理呈中或重度不典型增生、绒毛状腺瘤或混合性腺瘤属于高危组病例。1或2个直径小于1cm的管状腺瘤且没有中重度不典型增生属于低危组病例。进行危险分层可以区分高危性患者,减少低危性患者随访频率,避免不必要的医疗资源浪费。更多还原

【Abstract】 Objective To analysis of the risk factors associated with recurrent colorectal adenomatous polyps and explore the effective clinical surveillance strategy after polypectomy.Methods A total of 327 patients undergoing polypectomy and taken 1-4 times surveillence colonosopy within 4-95 months were retrospectively analyzed.The characteristics of adenomas were recorded on initial colonoscopy,including age,gender,number, size, pathological type and degree of atypical hyperplasia; We defined a new adenomas or cancer as a significant outcome on the surveillance colonoscopy,analysis of the risk factors associated with recurrence and the relations of recurrence rate and surveillance interval.Results 327 patients in the multiple regression analysis showed that the risk factors of adenomas recurrence include polyp diameter, number, pathological type and degree of atypical hyperplasia, not include age and gender. We can defined the high-risk adenomas(number≥3, diameter≥1cm, tubulovillous or villous adenoma and high-grade dysplasia) and the low-risk adenomas(1 or 2 less than 1cm in diameter, tubular adenomas and without high-grade dysplasia).Compared with the low-risk group, the high-risk group had a significant raise of comulative hazard of recurrence, the recurrence rate of low-risk group has not a significant difference in the surveillance interval within 3 years,3-5 years or over 5 years; conversely, a significant difference in high-risk group in the same surveillance interval.Conclusions Among our patients, the recurrence rate of adenoma after polypectomy increased with polyp size, number, tubulovillous or villous adenoma and high-grade dysplasia. We can classify adenoma patients into high risk groups or low risk groups by risk stratification of adenomas,and save the medical resource of surveillance colonosopy.更多还原