成春丽

[摘要] 目的 分析大腸息肉患者内镜下的分布特点、临床表现、大小、病理类型及其之间的相互关系。 方法 对门诊及住院大肠息肉患者的临床表现、内镜特点及病理资料进行总结和分析。 结果 98例大肠息肉患者中，男66例，女32例；好发年龄以20～75岁为主，占71.21%；临床表现以便血（59.18%）、腹痛（8.16%）及腹泻（24.49%）为主，且女性以腹泻为首诊者较男性明显增高（P<0.05），男性患者以便血为首诊者较女性明显增高（P<0.05）。病变部位分布直肠最多，占33.88%，乙状结肠占31.40%，降结肠占20.66%，横结肠占8.26%，升结肠占6.61%；炎性、增生性、管状腺瘤、绒毛状腺瘤、混合性腺瘤和部分癌变分别占7.83%、54.77%、18.16%、10.34%，6.81%和2.11%。绒毛状腺瘤、混合性腺瘤体积较其他类型息肉明显增大。 结论 20～75岁大肠息肉发病率较高，临床表现以便血、腹泻及腹痛为主；男性患者以便血为首诊者较女性明显增高，而女性以腹泻为首诊者较男性明显增高，息肉好发部位为左半结肠；病理类型以增生性息肉和腺瘤性息肉常见；其中2.11%的肠息肉局灶癌变，所以发现大肠息肉应尽可能切除，预防息肉癌变。

[关键词] 大肠息肉；内镜；病理；临床表现

[中图分类号] R735.34 [文献标识码] A [文章编号] 1673-9701（2017）23-0023-03

[Abstract] Objective To analyze the distribution characteristics， clinical manifestation， size and pathological type of colorectal polyps in patients under endoscopy， and to study the relationship between them. Methods The clinical manifestations， endoscopic features and pathologic data of outpatients and hospitalized patients with colorectal polyps were summarized and analyzed. Results There were 66 males and 32 females in 98 cases of colorectal polyps. The predilection agewas 20 to 75 years old， accounting for 71.21%. Hematochezia（59.18%）， abdominal pain （8.16%） and diarrhea （24.49%） were the main clinical manifestations. And women with diarrhea as the first consultation were significantly more than men（P<0.05）. Male patients with hematochezia for the first consultation were significantly more than women （P<0.05）. The rectal site was the most in the distribution of lesions， accounting for 33.88%， with 31.40% in sigmoid colon， 20.66% in descending colon， 8.26% in transverse colon and 6.61% in ascending colon. Inflammatory， proliferative， tubular adenoma， villous adenoma， mixed adenoma， partial cancer accounted for 7.83%， 54.77%， 18.16%， 10.34%， 6.81%， 2.11%， respectively. The volumeof villous adenoma and mixed adenoma were significantly bigger than other types of polyps. Conclusion The incidence of colorectal polyps in patients from 20 to 75 years old is high， and the clinical manifestations are mainlyhematochezia， diarrhea and abdominal pain. Male patients with hematochezia for the first consultation are significantly more than women， while women with diarrhea for the first consultation are more than men. The predilection site is the left colon. Hyperplastic polyps and adenomatous polyps are the common pathological type. 2.11% of the intestinal polyps cancer are focal cancerous. Therefore， once the colorectal polyps are detected， they should be removed as far as possibleto prevent polyps canceration.endprint

[Key words] Colorectal polyps； Endoscopy； Pathology； Clinical manifestations

结肠黏膜表面突出到肠腔的息肉状病变称为结肠息肉。大肠息肉分为腺瘤样和非腺瘤样息肉，其中腺瘤性息肉常常具有不典型增生，发展为结肠癌的概率达36.5%～88.9%[1]。因此熟悉每种息肉的内镜下特点，及时治疗大肠息肉，是预防结肠癌的有效途径。本文对我院行电子肠镜检查发现的大肠息肉进行相关性分析，内容包括临床特点，内镜和病理特点，对了解大肠息肉的发生、发展规律提供更多的临床资料。现报道如下。

1 资料与方法

1.1 一般资料

选取我院2016年1月～2017年1月间门诊和住院患者，行电子肠镜检查发现大肠息肉98例，排除炎症性肠病假性息肉患者。共发现息肉121枚，其中男66例（67.3%），女32例（32.7%），男女之比为2.06∶1。年龄20～75岁。主要临床表现包括有腹痛、腹泻、便秘、大便性状改变、便血等，多发息肉者35例，分别给予活检钳除或高频电切，并送病理检查。按照息肉发生部位和病理学类型分别进行统计比较。

1.2方法

所有患者口服复方聚乙二醇散套装准备肠道，使用奥林巴斯CF-H290I行肠镜检查，尽量插至回肠末端，常规模式下观察息肉部位、形态、大小，接近病变表面观察息肉表面腺管开口类型，采用NBI模式观察表面血管形态特点，详细记录息肉情况。……