大肠粘膜发育异常与大肠癌发生的病理形态学及临床流行病学研究

发布时间：2018-06-30 09:23

本文选题：粘膜发育异常 + 肠重复　；参考：《南方医科大学》2017年硕士论文

【摘要】：问题的提出:在临床病理工作中,我们发现大肠粘膜发育异常见于大肠癌病例中,并且可见癌旁大肠粘膜发育异常和大肠粘膜发育异常异型改变。在临床随访过程中,我们发现含大肠粘膜发育异常的患者常发生大肠癌,含大肠粘膜发育异常的大肠癌患者预后不良。因此大肠粘膜发育异常与大肠癌发生是否有关?其临床病理学意义何在?迄今为止,我们尚未见文献报道对上述问题的探讨,为此我们进行了本课题研究。研究目的:揭示大肠粘膜发育异常与大肠癌发生的关系及意义研究内容:探究大肠粘膜发育异常在大肠癌、大肠非癌性病变中的发生率有无差别,大肠粘膜发育异常与大肠癌发生的关联性及大肠粘膜发育异常与大肠癌患者临床病理参数及生存的关系。方法1.收集癌旁大肠粘膜发育异常和大肠粘膜发育异常的病例进行病理学观察和统计分析;2.观察大肠病变患者病理切片并分别统计大肠粘膜发育异常在大肠癌、大肠非癌性病变中的发生情况;3.收集大肠病变患者临床病理资料,应用历史性队列研究法分别统计含大肠粘膜发育异常的患者大肠癌的发生情况;4.收集大肠癌患者临床病理参数及生存情况,并分别统计大肠粘膜发育异常与临床病理参数及生存的关系。结果1.大肠粘膜发育异常,包括癌旁大肠粘膜发育异常、大肠粘膜发育异常异型,与大肠癌病变有密切联系。2.肠癌组肠重复发生率高于大肠非癌性病变组;肠癌组粘膜误位发生率高于大肠非癌性病变组;肠癌组粘膜内成腔发生率高于大肠非癌性病变组。3.肠重复暴露组与非暴露组在大肠癌的发生率上存在显著性差异,含肠重复患者大肠癌患病相对危险性比无肠重复患者增加4.218倍;粘膜误位暴露组与非暴露组在大肠癌的发生率上存在显著性差异,含粘膜误位患者大肠癌患病相对危险性比无肠重复患者增加3.421倍;粘膜内成腔暴露组与非暴露组在大肠癌的发生率上存在显著性差异,含粘膜内成腔患者大肠癌危险性比无粘膜内成腔患者增加3.234倍。4.肠重复的存在与患者性别、年龄、肿瘤大小、肿瘤部位、肿瘤分化程度、肿瘤浸润层次、淋巴结转移、远处转移、病理分期均无明显关联,肠重复是影响大肠癌患者生存的独立预后因素;粘膜误位的存在与患者肿瘤分化程度、肿瘤浸润层次有明显关联,与患者性别、年龄、肿瘤大小、肿瘤部位、淋巴结转移、远处转移、病理分期均无明显关联,粘膜误位是影响大肠癌患者生存的独立预后因素;粘膜内成腔的存在与患者性别、年龄、肿瘤大小、肿瘤部位、肿瘤分化程度、肿瘤浸润层次、淋巴结转移、远处转移、病理分期均无明显关联,粘膜内成腔不是影响大肠癌患者生存的预后因素。结论大肠粘膜发育异常,包括肠重复、粘膜误位和粘膜内成腔,与大肠癌的发生有关,可作为大肠癌的癌前病变。
[Abstract]:In the clinicopathological work, we found that the abnormal development of colorectal mucosa was found in colorectal cancer cases, and the abnormal development of adjacent colorectal mucosa and abnormal development of colorectal mucosa were observed. During clinical follow-up, we found that patients with abnormal development of large intestinal mucosa often developed colorectal cancer, and those with abnormal development of large intestinal mucosa had poor prognosis. Therefore, is the abnormal development of large intestine mucosa related to the occurrence of colorectal cancer? What is its clinicopathological significance? So far, we have not seen the literature report on the above issues, so we have carried out the research. Objective: to explore the relationship between colorectal mucosal dysplasia and colorectal carcinogenesis. The relationship between the abnormal development of colorectal mucosa and the occurrence of colorectal cancer and the relationship between the abnormal development of colorectal mucosa and the clinicopathological parameters and survival of colorectal cancer patients. Method 1. Pathological observation and statistical analysis were carried out in the patients with abnormal development of the adjacent colorectal mucosa and the abnormal mucosa of the large intestine. To observe the pathological sections of patients with colorectal diseases and to count the occurrence of abnormal development of large intestine mucosa in colorectal cancer and non-cancerous lesions of large intestine. To collect the clinicopathological data of patients with colorectal lesions and to calculate the incidence of colorectal cancer in patients with colorectal mucosal dysplasia by historical cohort study. The clinicopathological parameters and survival status of colorectal cancer patients were collected, and the relationship between abnormal development of colorectal mucosa and clinicopathological parameters and survival were analyzed. Result 1. Abnormal development of colorectal mucosa, including abnormal development of adjacent colorectal mucosa, abnormal development of colorectal mucosa, has a close relationship with colorectal cancer lesions. The rate of intestinal repeat in colorectal cancer group was higher than that in colorectal non-cancerous lesion group; the rate of mucosal misposition in colorectal cancer group was higher than that in colorectal non-cancerous lesion group; the incidence of intramucosal cavity formation in intestinal cancer group was higher than that in colorectal non-cancerous lesion group. There was significant difference in the incidence of colorectal cancer between the two groups. The relative risk of colorectal cancer in patients with intestinal duplication was 4.218 times higher than that in patients without intestinal duplication. There was a significant difference in the incidence of colorectal cancer between the exposure group and the non-exposure group. The relative risk of colorectal cancer in patients with mucosal misalignment was 3.421 times higher than that in patients without intestinal duplication. There was a significant difference in the incidence of colorectal cancer between the exposure group and the non-exposure group. The risk of colorectal cancer in patients with intramucosal cavities was 3.234 times higher than that in patients without intramucosal cavities. There was no significant correlation between the presence of intestinal duplication and sex, age, tumor size, tumor location, tumor differentiation, tumor invasion level, lymph node metastasis, distant metastasis, pathological stage. Intestinal duplication is an independent prognostic factor affecting the survival of colorectal cancer patients. There was no significant correlation between distant metastasis and pathological staging. Mucosal misplacement was an independent prognostic factor affecting the survival of colorectal cancer patients, and the presence of intramucosal cavities was associated with sex, age, tumor size, tumor location, tumor differentiation. Tumor invasion, lymph node metastasis, distant metastasis and pathological stage were not significantly correlated. Intramucosal lumen formation was not a prognostic factor for the survival of colorectal cancer patients. Conclusion the abnormal development of large intestine mucosa, including intestinal duplication, mucosal mislocation and intramucosal cavity formation, is associated with the occurrence of colorectal cancer and can be used as precancerous lesion of colorectal cancer.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.34

【参考文献】