【作者】 刘恒；

【导师】 刘文天；

【作者基本信息】 天津医科大学 ， 内科学 消化系病， 2023， 硕士

【摘要】 目的:研究并总结了炎性纤维性息肉的临床表现、内镜及超声内镜下的特征、所采用手术方式的治疗效果等特点,对炎性纤维性息肉有更加深入的的认识,为提高对炎性纤维性息肉的诊断和治疗提供依据。方法:回顾性分析天津医科大学总医院2014年6月-2022年8月行胃肠镜检查的患者,内镜下活检或手术切除获取病理标本,由高年资病理医师诊断,确诊为炎性纤维性息肉。收集获取患者以下基本临床资料:1)患者一般资料、临床表现;2)内镜下病变形态,位置、大小;3)超声内镜病变起源、回声形态;4)手术方式及术后治疗效果。并对收集的相关资料进行统计学分析。本课题中的相关数据运算均通过统计软件SPSS26.0进行数据统计分析。结果:1.年龄与性别:129例患者中女性85例,占比65.9%,男性44例,占比34.1%。患者平均年龄(56.55±11.20)岁。2.临床表现:病理确诊为炎性纤维性息肉的129例患者中有50例患者有腹部不适症状,占比38.8%;14例患者有大便习惯改变,占比10.9%;12例患者表现为反酸烧心,占比9.3%;5例患者有大便带血,占比3.9%;3例患者表现为恶心呕吐,占比2.3%;1例患者有贫血乏力,占比0.8%;44例患者为查体发现,占比34.1%。3.病变部位:129例炎性纤维性息肉患者中,74例患者病变位于胃部,占比57.4%;55例患者病变位于结直肠,占比42.6%。病变位于胃部的74例患者中,病变位于贲门5例,占比6.8%;病变位于胃底3例,占比4.1%;病变位于胃体11例,占比14.9%;病变位于胃角2例,占比2.7%;病变位于胃窦51例,占比68.9%;病变位于幽门2例,占比2.7%。病变位于结肠的55例患者中,病变位于升结肠8例,占比14.5%;病变位于横结肠15例,占比27.3%;病变位于降结肠7例,占比12.7%;病变位于乙状结肠15例,占比27.3%;病变位于直肠10例,占比18.2%。以横结肠的脾曲为界,左半结肠包括远端1/3的横结肠、降结肠、乙状结肠和直肠,右半结肠包括盲肠、升结肠和近端2/3的横结肠。病变位于右半结肠患者19例,占比34.5%;病变位于左半结肠患者36例,占比65.5%。4.病变大小:34例患者病变大小≤0.5cm,占比26.4%;52例患者病变大小0.6-1cm,占比40.3%;25例患者病变大小1.1-1.5cm,占比19.4%;18例患者病变大小>1.5cm,占比14.0%。5.超声内镜特征:129例炎性纤维性息肉患者中有22例患者完善术前超声内镜,其中12例患者病变起源为粘膜层,占比54.5%;10例患者病变起源为粘膜下层,占比45.5%。8例患者超声内镜提示低回声,占比36.4%;2例患者超声内镜提示中低回声,占比9.1%;5例患者超声内镜提示中等回声,占比22.7%;4例患者超声内镜提示中强回声,占比18.2%;3例患者超声内镜提示混杂回声,占比13.6%。6.手术方式:在纳入的129例患者中有49例患者住院行ESD或EMR治疗,均在内镜下完整切除病变组织。其中16例患者行ESD治疗,33例患者行EMR治疗。ESD组住院天数10(8,,1)天,EMR组住院天数6(5,10)天。ESD组住院费用27546.23(24114.66,33457.78)元,EMR组住院费用15354.34(11835.32,19959.43)元。结论:炎性纤维性息肉患者女性多见于男性,病变多见于中老年人。病变多为单发,病变大小为数毫米至数厘米不等。病变多累及胃,以胃窦部多见。内镜下治疗是炎性纤维性息肉的主要治疗方式,患者术后恢复良好。目前对于炎性纤维性息肉的研究较少,本项研究对于炎性纤维性息肉的临床表现、内镜特征、超声内镜特征、手术方式进行分析总结,从而协助炎性纤维性息肉的发现、诊断和治疗。更多还原

【Abstract】 Objective:To study the clinical manifestations,endoscopic features,ultrasound endoscopic features,and surgical methods of inflammatory fibrous polyps,and summarize the pathogenesis characteristics of inflammatory fibrous polyps,so as to facilitate clinicians to better understand inflammatory fibrous polyps,and promote the diagnosis and treatment of inflammatory fibrous polyps in clinical work.Method:A retrospective analysis was performed on patients who underwent gastrointestinal endoscopy in General Hospital of Tianjin Medical University from June 2014 to August 2022 and were diagnosed with inflammatory fibrous polyps after pathological section observation by senior pathologists.The general information,endoscopic features,ultrasound endoscopic features,and surgical methods of inflammatory fibrous polyps were collected.The relevant data operations in this topic are statistically analyzed using SPSS26.0.Results:1.Age and gender:Among 129 patients,85 were female(65.9%)and 44 were male(34.1%),with an average age of(56.55±11.20)years.2.Clinical manifestations:50 patients had abdominal discomfort(38.8%);14 patients had stool habit change(10.9%);12 patients had acid reflux heartburn(9.3%);5 patients had blood in stool(3.9%);3 patients had nausea or vomiting(2.3%);1 patient had anemia and weak(0.8%);44 patients were examined(34.1%).3.Lesion sites:74 patients had lesions located in the stomach(57.4%),and 55 patients had lesions located in the colorectum(42.6%).Among the 74 patients with gastric inflammatory fibrous polyps,5 cases(6.8%)were located in the cardia,3 cases(3.1%)were located in the fundus ventriculi,11 cases(14.9%)were located in the corpus ventriculi,2 cases(2.7%)were located in the gastric horn,51 cases(68.9%)were located in the gastric antrum,and 2 cases(2.7%)were located in the pylorus.Among the 55patients with colorectal inflammatory fibrous polyps,8 cases(14.5%)were located in the ascending colon,15 cases(27.3%)were located in the transverse colon,7cases(12.7%)were located in the descending colon,15 cases(27.3%)were located in the sigmoid colon,and 10 cases(18.2%)were located in the rectum.19 cases(34.5%)were located in the right colon,36 cases(65.5%)were located in the left colon.4.Lesion size:The lesion size of 34 patients was≤0.5cm,accounting for 26.4;The lesion size of 52 patients was 0.6-1cm,accounting for 40.3%;The lesion size of 25patients was 1.1-1.5cm,accounting for 19.4%;The lesion size of 18 patients was>1.5cm,accounting for 14.0%.5.ultrasound endoscopic features:Among the 129 patients with inflammatory fibrous polyps,22 patients had improved preoperative ultrasound endoscopy.The lesions of 12patients originated mucosal layer,accounting for 54.5%;The lesions of 10 patients originated in the submucosal layer,accounting for 45.5%.8 cases(36.4%)were shown low echo,2 cases(9.1%)were shown moderate and low echo,5 cases(22.7%)were shown moderate echo,4 cases(18.2%)were shown moderate strong echo,and 3cases(13.6%)were shown mixed echoes.6.surgical methods:Among the 129 patients with inflammatory fibrous polyps,16patients underwent ESD,and the mean hospital stay was 10 days,and the mean hospital cost was 27546.23 yuan.33 patients underwent EMR,and the mean hospital stay was6 days,and the mean hospital cost was 15354.34 yuan.Conclusion:Inflammatory fibrous polyps are more common in women than men,and more common in middle-aged and elderly people.Lesions are mostly single,with lesions ranging in size from a few millimeters to several centimeters.Lesions often involve the stomach,and the antrum is more common.Endoscopic treatment is the mainstay of treatment for inflammatory fibrous polyps,and patients recover well after surgery.At present,there are few studies on inflammatory fibrous polyps,and this study analyzes and summarizes the clinical manifestations,endoscopic features,ultrasound endoscopic features and surgical methods of inflammatory fibrous polyps,so as to assist the detection,diagnosis and treatment of inflammatory fibrous polyps.更多还原