1347例大肠息肉的临床、病理及癌变特点分析

发布时间：2018-03-01 10:21

  本文关键词： 大肠息肉 结肠镜 病理学　出处：《大连医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：分析大肠息肉患者的发病情况、临床症状、内镜表现、病理类型及癌变特点,以期提高认识、早期发现、及时治疗。方法：选取2012年1月至2014年6月于我院行结肠镜检查的3798例住院患者,共检出的大肠息肉患者1347例,发现息肉总计4005枚,其中1247例患者通过内镜下活检或完整摘除明确病理性质。检查过程中详细记录大肠息肉患者的性别、年龄、临床表现、内镜特点、病理类型及癌变情况,制定分类及评价标准并建立数据库,根据资料特点采用PearsonΧ2检验、Fisher确切概率法、二元非条件Logistic回归分析及Kruskal-Wallis秩和检验进行统计学分析,差异有统计学意义时进行组间多重比较。结果：大肠息肉患者的检出率为35.47%,其中青、中、老年组检出率分别为15.07%、33.4%、46.14%,男性明显高于女性(41.61%29.28%),差异有统计学意义(P0.01),回归分析显示年龄和性别为大肠息肉发生的独立危险因素,其中年龄危险因素较高。临床症状主要表现为腹痛37.79%、腹泻12.69%、便秘8.69%、便血8.54%、腹胀7.72%、消瘦4.31%、腹泻与便秘交替2.75%,无消化道症状者占17.52%,其中中、老年组便血症状及无症状者较青年组明显增多,而腹泻发生率降低,青年组腹痛高于老年组,组间差异具有显著性(P0.017)。息肉分布主要位于远端大肠,其中直肠占32.03%、乙状结肠27.49%、横结肠15.13%,不同年龄或病理类型组息肉分布特点未见明显差异(P0.05)。大肠息肉发生数量以多发为主(63.25%),但青年组中单发较常见(50.96%)；大小以直径≤0.5cm为主(81.35%),形态特点主要表现为无蒂(Ⅰ、Ⅱ型,58.60%)、表面光滑(86.82%),以上特征在不同年龄组中比较差异显著(P0.05)。病理类型构成主要为管状腺瘤40.13%、增生性息肉33.22%、炎性息肉18.03%,与青、中年组以非腺瘤性息肉为主不同,老年组中腺瘤较多(56.08%,P0.017)：男性与女性各病理类型比例相似(P0.05)；腺瘤常见于多发(54.41%)、直径较大0.5cm(73.35%)、[II、Ⅳ型(亚蒂、有蒂型,62.87%)、分叶(88.43%)的息肉中,差异有显著性意义(P0.01)。所有类型息肉均可发生异型增生,以轻、中度异型为主,其中腺瘤占主要部分(88.11%),重度异型增生及癌变均见于腺瘤,癌变率为2.67%,以绒毛状腺瘤和绒毛管状腺瘤癌变率最高,常见于多发(1.7%)、表面分叶(10.32%)、直径2.0cm(11.58%)的息肉中,差异有显著性(P0.05)；不同年龄、性别、部位及分型组的癌变率比较未见明显不同(P0.05)。结论：1.年龄和性别是大肠息肉发生的危险因素。2.大肠息肉的大小以直径≤0.5cm多见,形态以光滑、无蒂为主,分布常见于直肠和乙状结肠,其分布特点与年龄和病理类型无关。3.腺瘤具有易多发、体积大、形态不规则的特点,好发于老年；多发、直径2.0cm、表面分叶或伴重度异型增生的绒毛管状腺瘤和绒毛状腺瘤发生癌变可能性大。4.有消化道症状者和中老年人群需早期行结肠镜检查,对发现的息肉均应完整切除,并根据病理指导下一步随访。
[Abstract]:Objective: to analyze the incidence, clinical symptoms, endoscopic manifestations, pathological types and canceration characteristics of patients with colorectal polyps in order to improve their understanding and early detection. Methods: from January 2012 to June 2014, we selected 3 798 inpatients who underwent colonoscopy in our hospital. A total of 1 347 cases of colorectal polyps were detected, and a total of 4 005 polyps were found. Among them, 1247 patients were confirmed by endoscopic biopsy or complete excision. The sex, age, clinical manifestations, endoscopic features, pathological types and canceration of colorectal polyps were recorded in detail during the examination. The classification and evaluation criteria were established and the database was established. According to the characteristics of the data, the Pearson X 2 test and Fisher exact probability method, binary non conditional Logistic regression analysis and Kruskal-Wallis rank sum test were used for statistical analysis. Results: the detection rate of colonic polyps was 35.47. The positive rate in the elderly group was 15.07 and 33.4 respectively. The incidence rate of male was significantly higher than that of female. The difference was statistically significant (P 0.01). The regression analysis showed that age and sex were independent risk factors for colorectal polyps. The main clinical symptoms were abdominal pain 37.79, diarrhea 12.69, constipation 8.69, constipation 8.69, constipation 8.54, abdominal distension 7.72, weight loss 4.31, diarrhea and constipation alternating 2.75. The hematochezia symptoms and asymptomatic symptoms in the elderly group were significantly higher than those in the young group, but the incidence of diarrhea was lower. The abdominal pain in the young group was higher than that in the elderly group, and there was a significant difference between the two groups (P 0.017). The distribution of polyps was mainly located in the distal large intestine. There was no significant difference in the distribution of polyps in different age or pathological type groups (P 0.05). The number of polyps in large intestine was mainly multiple and 63.2525, but in the young group, the single occurrence was more common than that in the young group, and the diameter 鈮，

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