[摘要] 目的 探讨结直肠锯齿状病变（serrated lesions，SL）合并进展期肿瘤（advanced neoplasia，AN）的发生率并分析SL合并AN的危险因素。方法 选取2021年10月1日至2023年9月30日于湖州市第一人民医院行结肠镜检查且术后病理提示为SL的297例患者为研究对象。根据是否合并AN分为合并组（n=33）和非合并组（n=264），比较两组患者的临床病理差异，并分析SL合并AN的危险因素。结果 年龄≥50岁、男性、有息肉病史、息肉直径及不同的SL分型是SL合并AN的危险因素，两组比较差异有统计学意义（Plt;0.05）。Logistic回归分析，年龄、男性、有息肉病史、SL直径是SL合并AN的独立危险因素。结论 男性、年龄较大、既往息肉病史、SL病变较大的患者更易合并AN。

[关键词] 锯齿状病变；腺瘤；进展期肿瘤；危险因素

[中图分类号] R735"" [文献标识码] A"" [DOI] 10.3969/j.issn.1673-9701.2025.20.006

Analysis of factors affecting colorectal serrated lesions combined with advanced neoplasia

ZHANG Wentian， YAO Linhua， LU Huifei， YU Jing

Department of Gastroenterology， the First People’s Hospital of Huzhou， Huzhou 313000， Zhejiang， China

[Abstract] Objective To investigate the incidence of colorectal serrated lesions （SL） combined with advanced neoplasia （AN） and to analyze the risk factors for SL combined AN. Methods A total of 297 patients with colorectal polyps detected by endoscopy and pathologically suggestive of SL from 1st October 2021 to 30th September 2023 in the First People’s Hospital of Huzhou. They were divided into combined group（n=33） and uncomplicated group （n=264） according to whether they were combined with AN or not， and the clinicopathologic differences between two groups were compared and the coexisting risk factors were analyzed. Results Age≥50 years， male， history of polyps， polyp size and different SL subtypes were all risk factors for SL combined with AN， and the difference was statistically significant （Plt;0.05）. Logistic regression analysis revealed that age， male， history of polypos， and SL size were independent risk factors for SL combined with AN. Conclusion Males， older age， previous history of polyps， and larger SL lesions were more likely to have combined AN.

[Key words] Serrated lesions; Adenoma; Advanced neoplasia; Risk factor

结直肠癌（colorectal cancer，CRC）是常见的癌症，其发生主要有3种路径：腺瘤–癌、锯齿状病变–癌、de-novo癌；从发生的频率上来说，腺瘤路径最常见，其次是锯齿状途径，但从进展速度上来说，锯齿状途径癌变速度较快^[1-3]。近年来随着电子染色和放大内镜技术的成熟及对结直肠锯齿状病变（serrated lesions，SL）认识的提升，SL检出率提高^[4]。在临床中发现，SL合并腺瘤的现象屡见不鲜，但关于SL合并进展期肿瘤（advanced neoplasia，AN）发生的研究却相对匮乏。本研究分析SL患者的内镜下特征，并探讨SL合并AN的发病率情况及其危险因素。

1 "对象与方法

1.1 "研究对象

选取2021年10月1日至2023年9月30日于湖州市第一人民医院行结肠镜检查且术后病理提示为SL的297例患者为研究对象。根据是否合并AN分为合并组（n=33）与非合并组（n=264）。纳入标准：①年龄gt;18岁；②内镜检查提示为结肠息肉、大肠侧向发育性肿瘤、结肠肿物，并行内镜下完整切除；……