985例结直肠癌筛查高危人群肠息肉临床特征分析

韩冰*申玉翠徐建华高鹏张其胜

上海市第一人民医院分院消化科(200081)

背景：结直肠息肉为消化道的常见疾病，与结直肠癌的发生、发展关系密切。目的：探讨结直肠癌筛查高危人群中肠息肉的临床特点。方法：选取2013年4月—2014年12月粪便隐血试验阳性或结直肠癌高危因素调查表评价存在高危因素并在上海市第一人民医院分院接受结肠镜检查的虹口区社区居民。分析结直肠息肉的检出率、不同性别人群、年龄段的特征，以及结直肠息肉的发病部位、形态、病理类型等特点。结果：共985例息肉患者纳入本研究，息肉总体检出率为48.7%，男性检出率明显高于女性(58.7%对38.9%；χ2=79.788，P<0.01)。不同年龄段息肉检出率差异有统计学意义(χ2=23.820，P<0.01)。左半结肠息肉检出率明显高于右半结肠(62.4%对37.6%，χ2=190.643，P<0.01)。隆起型息肉0-Ⅰ的总体检出率94.5%，平坦型息肉0-Ⅱa为48.3%。腺瘤性息肉检出率高于非腺瘤性息肉(59.3%对47.1%，χ2=27.326，P<0.01)。119例患者的两次病理结果不一致。仅17.8%息肉摘除者术后行结肠镜随访，其中62.3%息肉复发。结论：结直肠癌筛查高危人群有较高的结直肠息肉发生率，高质量的结肠镜检查和及时有效的手术可降低结直肠癌的发生。

关键词结直肠肿瘤；肠息肉；结肠镜检查；筛查

Analysis of Clinical Features of 985 High-risk People with Intestinal Polyps in Colorectal Cancer ScreeningHANBing,SHENYucui,XUJianhua,GAOPeng,ZHANGQisheng.DepartmentofGastroenterology,BranchofShanghaiFirstPeople’sHospital,Shanghai(200081)

Background: Colorectal polyps are common gastrointestinal diseases, which are closely related to the development of colorectal cancer. Aims: To investigate the clinical features of high-risk people with intestinal polyps in colorectal cancer screening. Methods: People in Hongkou District, Shanghai, who were positive in fecal occult blood test or of the high risk category in colorectal cancer questionnaire from April 2013 to December 2014 were enrolled, and colonoscopy was performed at Branch of Shanghai First People’s Hospital. The overall detection rate, gender, age, location of lesion, morphology, and pathology were analyzed. Results: A total of 985 patients with colorectal polyps were recruited in this study. The overall detection rate of polyps was 48.7%. The prevalence of colorectal polyps was significantly higher in males than in females (58.7%vs. 38.9%; χ2=79.788,P<0.01). The detection rates of colorectal polyps in different age groups were statistically significant (χ2=23.820,P<0.01). Detection rate of polyps was significantly higher in left colon than in right colon (62.4%vs. 37.6%; χ2=190.643,P<0.01). The overall detection rate of protruding lesion 0-Ⅰ was 94.5%, and slightly elevated lesion 0-Ⅱa was 48.3%. Detection rate of adenomatous pylops was significantly higher than non-adenomatous pylops (59.3%vs. 47.1%; χ2=27.326,P<0.01). The histological results were differed between two examination in 119 patients. Only 17.8% of the patients operated were followed up by colonoscopy, and polyps recurred in 62.3% of them. Conclusions: A higher incidence of colorectal polyps is found in people with high risk of colorectal cancer screening. High quality colonoscopy examination and effective operation in time can reduce the incidence of colorectal cancer.

Key wordsColorectal Neoplasms;Intestinal Polyps;Colonoscopy;Screening

结直肠癌是我国目前最为常见的恶性肿瘤之一，近年其发病率以4.71%逐年递增，上海结直肠癌的发病数已从上世纪70年代初的第6位升至目前的第2位，发病率从12/10万增至56/10万。目前，作为上海市重大公共卫生服务项目的“社区居民结直肠癌筛查”已正式启动，可提供结直肠癌危险度评估、粪便隐血试验检测和相关防治教育咨询等服务。肠息肉因其存在恶变倾向而备受关注。随着内镜的普及以及内镜治疗技术的进步，内镜下摘除成为息肉的首选治疗方法。本研究通过对参加上海市结直肠癌筛查的高危人群行结肠镜检查，旨在总结分析肠息肉的临床特征。

对象与方法

一、 纳入和排除标准

收集2013年4月—2014年12月参加上海市结直肠癌筛查且于上海市第一人民医院分院接受结肠镜检查的虹口区社区居民。……