结直肠腺瘤性息肉经内镜切除术后复发影响因素分析

发布时间：2018-02-26 16:12

本文关键词： 腺瘤性息肉复发因素内镜下切除术　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:结直肠癌是常见的消化道恶性肿瘤之一。随着我国居民生活水平的提高,我国结直肠癌的发病率和死亡率逐年上升。结直肠腺瘤被认为是结直肠癌主要的癌前病变。早期发现结直肠腺瘤并进行治疗能在一定程度上控制结直肠癌的发病率。结肠镜被公认为是目前最有效的结直肠癌筛查方法。在发现腺瘤的同时还可以进行内镜下切除。但是结直肠腺瘤内镜下切除后有较高的复发率,所以结直肠腺瘤镜下治疗后的结肠镜监测十分必要。而由于结肠镜检查中漏诊等问题的存在,大多数国内医师要求腺瘤患者在较短时间内密切随访。频繁的结肠镜检查除了导致医疗资源浪费外,还使患者反复的承受肠镜检查时带来的痛苦。因此针对于中国人群中结直肠腺瘤患者在腺瘤完整切除后真正的随访时间有待于进一步研究。目的:本研究通过回顾性分析吉林地区结直肠腺瘤患者经内镜下腺瘤切除后复发情况,目的找出腺瘤复发相关的影响因素。筛选出具有复发倾向的高危人群,对临床上该类患者的随访观察提供参考。材料与方法:回顾性分析2007年1月至2015年12月期间于吉林大学第一医院内镜中心经内镜下行大肠腺瘤性息肉内镜下切除后复发的患者临床资料和腺瘤特征。以初次结肠镜为基线,记录患者性别、年龄、肠道准备情况和腺瘤的大小、数目、基底、病理类型、病理组织学分级和切除方式等9个方面。通过单因素统计学分析,筛选出腺瘤性息肉复发的影响因素。将具有统计学意义的因素进行多因素统计学分析找出腺瘤性息肉复发的独立危险因素。结果:1、研究共纳入221例患者,其中35例在随访期间行结肠镜检查发现新的腺瘤,复发率15.84%。术后1、3和5年累积复发率分别为3.8%、16.5%和31.4%。2、单因素分析结果显示腺瘤大小(P=0.001)、腺瘤基底部(P=0.018)、腺瘤病理类型(P=0.029)、腺瘤病理组织学分级(P=0.001)和切除腺瘤的术式(P=0.001)5个因素具有统计学意义。而性别(P=0.202)、年龄(P=0.054)、肠道准备(P=0.114)、腺瘤数目(P=0.332)等对腺瘤复发无明显相关性。3、多因素分析结果显示腺瘤大小(HR=1.821,P=0.007)、腺瘤病理组织学分级(HR=2.082,P=0.014)具有统计学意义。4、生存曲线显示腺瘤直径越大、腺瘤病理组织学分级越高,患者复发的可能性越大。结论:1、腺瘤大小、腺瘤基底、切除术式、腺瘤类型、腺瘤病理组织学分级是影响腺瘤性息肉复发的因素。2、腺瘤大小、腺瘤病理组织学分级是腺瘤性息肉复发的独立危险因素,腺瘤直径越大、腺瘤病理组织学分级越高,腺瘤复发的可能性越大。3、若患者腺瘤直径大于1cm且术后病理提示为高级别上皮内瘤变,建议患者术后21个月内复查结肠镜。
[Abstract]:Background: colorectal cancer is one of the most common malignant tumor of digestive tract. With the improvement of Chinese living standards in China, the incidence and mortality of colorectal cancer is increasing year by year. Colorectal adenomas are considered major precancerous lesions of colorectal cancer. Early detection of colorectal adenoma and treatment can control the incidence of colorectal cancer in a certain degree. Colonoscopy is recognized as the most effective screening method for colorectal cancer. Found in adenomas can also be endoscopic resection. But after endoscopic resection of colorectal adenoma with a higher recurrence rate, so colorectal intestinal adenoma endoscopic colonoscopic surveillance after treatment is necessary. But because of colonoscopy misdiagnosis of problems, most domestic physician requests adenoma patients in a relatively short period of time. The frequent close follow-up colonoscopy in addition to causing the waste of medical resources, but also affected Repeated under colonoscopy pain. So for patients with colorectal adenoma China crowd in the follow-up time after complete resection of adenoma really needs to be further studied. Objective: through the retrospective analysis of patients with colorectal adenoma in Jilin by endoscopic adenoma recurrence after this study, to find out the factors related to recurrence. Identify high-risk patients with a relapse tendency, to provide the reference for the observation of the patients were followed up clinically. Materials and methods: a retrospective analysis from January 2007 to December 2015 during the endoscopy center of No.1 Hospital of Jilin University after endoscopic colorectal adenomatous polyps after endoscopic resection of recurrence in patients with clinical data and adenoma characteristics. With initial colonoscopy as the baseline. Record the sex, age, bowel preparation and adenoma size, number, basal, pathological type, pathological group 9 aspects of histological grading and resection methods. Through single factor statistical analysis to find out influencing factors of recurrence of adenomatous polyps. The factors were statistically analyzed using multivariate find independent risk factors for the recurrence of adenomatous polyps. Results: 1. The study included 221 patients, including 35 cases of colonoscopy check the line during the follow-up period found new adenomas, the recurrence rate of 15.84%. after 1,3 and 5 year cumulative recurrence rates were 3.8%, 16.5% and 31.4%.2, the single factor analysis showed that the tumor size (P=0.001), basal adenoma (P=0.018), adenoma pathological type (P=0.029), histological grade (P=0.001) and adenoma resection of adenoma the type of surgery (P=0.001) with statistical significance. 5 factors and gender (P=0.202), age (P=0.054), bowel preparation (P=0.114), the number of adenomas (P=0.332) on the recurrence of.3 had no significant correlation, multivariate analysis According to the size of adenoma (HR=1.821, P=0.007), adenoma (HR=2.082, P=0.014) histopathological grade was statistically significant.4 survival curves showed that the larger the diameter of adenoma, adenoma pathological grade is high, the greater the possibility of recurrence. Conclusion: 1. The size of adenoma, adenoma resection of adenoma type, substrate type, histological grade is adenoma factors affecting the recurrence of adenomatous polyps in.2, the size of adenoma, adenoma pathological grade are independent risk factors for the recurrence of adenomatous polyps, adenoma of the larger diameter, the higher the tumor pathological grade, the greater the possibility of recurrence of.3, if the diameter is more than 1cm adenoma patients and postoperative pathology showed high grade intraepithelial neoplasia that review colonoscopy within 21 months suggested patients after operation.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.34

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