结肠息肉切除术后复发及随访间隔的研究

发布时间：2018-03-09 08:20

本文选题：结肠息肉　切入点：复发　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探究初次肠镜下息肉特征与复发的关系,及结肠息肉切除术后不同时间段内随访复发情况;并评估初次行结肠镜检查时发现高风险息肉的风险指标。方法:对2008~2016年在青岛大学附属医院行结肠镜下息肉切除术患者的资料进行回顾性分析,认真记录患者特征(年龄、性别、吸烟史、体重指数(BMI,亚洲人标准)、一级亲属患结肠癌或结肠息肉的家族史),初次肠镜下息肉特征(大小、数目、病理、部位)及随访中息肉复发情况,利用单因素和多因素Logistic回归,分析影响息肉复发的主要因素;根据初次结肠镜下息肉特征对患者风险进行分层即:无风险组(炎性息肉、增生性息肉)、低风险组(1~2枚直径1.0 cm的管状腺瘤)和高风险组(腺瘤数目≥3枚、直径≥1.0 cm管状腺瘤、有25%以上绒毛成分、高级别上皮内瘤变和非浸润癌),三组复发率的比较采用卡方检验,并用Kaplan-Meier生存分析法比较高风险组和低风险组患者累计复发风险;通过临床上的风险指标,包括年龄、性别、家族史、吸烟史、BMI,利用t检验和卡方检验预估患者初次结肠镜检查中存在高风险息肉的风险。结果:在单因素分析中,患者的年龄≥70岁,息肉的直径0.5 cm,数目2枚且散在分布于全结肠是复发的危险因素(P=0.00),病理类型中,相对于非浸润癌,非肿瘤性息肉不易复发(P=0.00),而管状腺瘤、管状绒毛状腺瘤、腺瘤伴有低级别、腺瘤伴有高级别与非浸润癌比较,P值均0.05,无统计学意义。在多因素分析中,息肉数目是复发的独立危险因素(OR=2.36,95%CI 1.06-5.25),年龄、息肉直径和部位在多因素分析中,并非是复发的相关危险因素;614名患者经历6~87个月不等随访时间,平均复发率为58.6%,在6~24个月、24~36个月、36~48个月、48~87个月4个时间段内,总体息肉的累计复发率为50.3%、61.7%、70.1%、75.0%;高风险组累计复发率分别为:60.1%、65.7%、80.7%、83.8%;低风险组累计复发率分别为:22.7%、40.0%、53.8%、65.4%。两组患者复发的累计风险存在差异(c2=17.17,P=0.00)。无风险组和低风险组分别在随访的48个月和36个月内未发现进展期腺瘤,而低风险组在随访的41个月发现一例息肉伴部分恶变,无风险组在随访中未发现结肠癌;高风险组在24个月发现4.1%(11/271)的进展期腺瘤(主要为直径≥1.0 cm管状腺瘤或含有绒毛成分),在随访的57个月和87个月发现2例浸润癌。患者的年龄、性别(男性)、吸烟史(既往吸烟和现在吸烟史)、BMI(≥23kg/m2)、家族史(一级亲属患结肠癌、结肠息肉史)(P0.05),可以预估患者存在高风险息肉的风险。年龄60岁、男性、有结肠癌、结肠息肉家族史,具有吸烟史的患者和超重患者在初次结肠镜检查中更容易发现高风险息肉。结论:1.初次结肠镜检查中,年龄、息肉的直径、数目、和散在分布于全结肠是复发的相关因素,其中数目是复发的独立危险因素,非肿瘤性息肉与其它病理类型比较不易复发。2.息肉的复发率随时间延长而增加,高风险组患者在息肉切除术后累计复发率高于低风险组患者。对于高风险组患者内镜下息肉切除术后的随访不应超过2年,低风险组可在3年左右,无风险组可延长至4年随访是安全的。3.年龄、性别、吸烟史、体重指数、家族史均与初次结肠镜检查中发现高风险息肉具有相关性。
[Abstract]:Objective: To explore the relationship between the characteristics and the recurrence of polyps of the first colonoscopy, and after resection of colonic polyps in different time recurrence condition; and to evaluate the initial colonoscopy found risk index high-risk polyps. Methods: 2008~2016 in Affiliated Hospital of Qiingdao University underwent colonoscopy polypectomy patients were retrospectively analysis of carefully recorded patient characteristics (age, gender, smoking history, body mass index (BMI, Asian standard), family history of first-degree relatives of colon cancer or colon polyps), initial colonoscopy polyp characteristics (size, number, pathology, location) polyp recurrence and follow-up, using single factor and multiple Logistic regression analysis, the main factors affecting the recurrence; risk stratification of patients according to characteristics of the initial polyp colonoscopy: no risk group (inflammatory polyps, hyperplastic polyps), low risk group (1~2 gold straight A diameter of 1 cm tubular adenoma) and high risk group (adenoma number 3, with diameter larger than 1 cm tubular adenoma, 25% villous component, high-grade intraepithelial neoplasia and non invasive carcinoma), the recurrence rate of the three groups were compared using chi square test, and compared with Kaplan-Meier survival analysis of high risk group and the low risk group had a cumulative risk of recurrence; through the clinical risk index, including age, gender, family history, smoking history, BMI, using t test and chi square test risk estimates are at high risk of polyps in patients with initial colonoscopy. Results: in univariate analysis, patients aged 70 old, polyp diameter 0.5 cm, number 2 and scattered in the whole colon is a risk factor for recurrence (P=0.00), pathological type, compared with non invasive carcinoma, non neoplastic polyp recurrence (P=0.00), and tubular adenoma, hairy tubular adenoma adenomas with low grade, velvet, adenoma With the high level and non invasive carcinoma, P value was 0.05, no statistical significance. In multivariate analysis, the number of polyps are independent risk factors of recurrence (OR=2.36,95%CI 1.06-5.25), age, polyp diameter and position in multivariate analysis, is not the risk factors of recurrence; experience 6~87 months follow-up in 614 patients, the average recurrence rate was 58.6%, in 6~24 months, 24~36 months, 36~48 months, 48~87 months the 4 time period, the overall cumulative recurrence of polyps was 50.3%, 61.7%, 70.1%, 75%; high risk group, the cumulative recurrence rate was respectively 65.7%, 80.7%, 60.1%, 83.8% the low risk group; the total relapse rate were 22.7%, 40%, 53.8%, two 65.4%. group differences in cumulative risk of recurrence in patients with (c2=17.17, P=0.00). No risk group and low risk group were followed up for 48 months and 36 months were found in advanced adenomas and low risk group in 41 follow up July found a case of malignant polyps associated with part, without the risk of colon cancer was not found during the follow-up period; high risk group found that 4.1% in 24 months (11/271) advanced adenomas (mainly with diameter larger than 1 cm tubular adenoma or villi, containing ingredients) found 2 cases of invasive carcinoma in the 57 months of follow-up and 87 months. The patient's age, gender (male), smoking (smoking history and smoking history now), BMI (more than 23kg/m2), family history (first-degree relatives of colon cancer, colonic polyp History) (P0.05), can estimate the risk in patients with high risk of polyps. The age is 60 years old, male, have family history of colon cancer, colonic polyps, with a history of smoking and overweight patients are more likely to find high-risk polyps in the initial colonoscopy. Conclusion: age 1. initial colonoscopy, and number of polyps, diameter, and scattered in the colon is the related factors of recurrence, which is the number of recurrence independent risk The risk factors of non neoplastic polyps and other pathological types are not easy to relapse.2. polyp recurrence rate increases with time and high risk groups of patients with polyps after resection of the cumulative recurrence rate is higher than the low risk group. For the follow-up should be no more than 2 years of high risk group of patients undergoing endoscopic polypectomy. The low risk group in 3 years or so, no risk can be extended to 4 years of follow-up is safe.3. age, sex, body mass index, smoking history, family history and initial colonoscopy found associated with high risk of polyps.

【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R656.9

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