胆囊疾患与结直肠息肉相关性的探讨与中医体质分布规律研究
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摘要
背景：胆囊结石和结直肠息肉都是消化系统常见疾病,胆囊切除术是治疗胆囊结石的主要方式之一。胆囊结石、胆囊切除术已被认为是结直肠癌的高危因素之一,而结直肠息肉特别是腺瘤已经被公认为结直肠癌的癌前病变,但胆囊切除与结直肠息肉的关系一直未受到重视,因此结直肠息肉病人的定期随访已经被提到防治早期大肠癌的高度上。
目的：通过研究部分结直肠息肉患者的病例资料,探讨胆囊疾患(胆囊结石、胆囊切除)与结直肠息肉是否存在相关性,并运用相关中医理论对其中腺瘤性息肉的患者进行体质分型,为临床上对有胆囊疾患的患者及早发现结直肠息肉并行内镜下治疗提供新的理论依据以及为结直肠息肉的防治提供中医体质学调养依据。
方法：收集2010年1月—2012年03月期间于江苏省中医院消化内镜中心门诊及病房行肠镜检查的部分患者400例,经结肠镜检查排除炎症性肠病、家族性腺瘤性息肉病Familial adenomatous polyposis (FAP)、黑斑息肉病(P-J综合征)、恶性肿瘤等疾病的患者388例,根据既往有无胆囊疾患分为胆囊疾患组(n=82)和对照组(n=306),对两组患者结直肠息肉的发生率、内镜下息肉表现和组织学类型进行分析；此外,根据《中医体质分类判定标准》对上述病例中病理类型为腺瘤性息肉的患者74例进行体质辨识,以上均采用Microsoft Excel建立数据库,并使用spssl7.0统计软件进行分析。
结果：胆囊疾患组结直肠息肉发生率高于对照组(42.7%对27.8%),且差异有统计学意义(OR=1.936,p=0.01<0.05)。两组患者息肉的部位无明显差异(P>0.05)；但胆囊切除患者腺瘤性息肉的发生危险显著高于对照组(OR=2.729,P=0.028<0.05)。此外调查还发现,腺瘤性大肠息肉的常见体质类型有痰湿质、湿热质、血瘀质、气郁质、气虚质、阳虚质、阴虚质、平和质、特禀质九种类型,其中痰湿质有31人,占41.89%；湿热质有25人,占33.78%；血瘀质有4人,占5.41%；气郁质有3人,占4.05%；气虚质有2人,占2.70%；阳虚质有7人,占9.46%；阴虚质有0人；平和质有1人,占1.35%；特禀质1人,占1.35%；平和质1人,占1.35%。
结论：1.伴有胆囊疾患的患者与结直肠息肉的关系与是否行胆囊切除并没有必然联系；
2.胆囊切除术后腺瘤性息肉的发生率明显增高；
3.胆囊结石、胆囊切除术是结直肠息肉患者发病的高危因素之一；
4.在腺瘤性结直肠息肉常见体质类型中,痰湿质、湿热质明显高于其他体质类型,约占发病人数的80%。
5.因此重视胆囊切除术后患者的早期结直肠癌和腺瘤性息肉的筛查和监测是非常必要的。
Background:Cholecystolithiasis and Colorectal polyps are both common disease of the dig estive system. Cholecystectomy is one of the main treatment of Cholecystolithiasis. Cholecystoli thiasis, cholecystectomy has been considered one of the risk factors for colorectal cancer, colorec tal polyps, especially adenomas has been recognized as a precancerous lesion of colorectal cance r, but the relationship between cholecystectomy and colorectal polyps has not been taken seriousl y, Therefore, regular follow-up of patients with colorectal polyps have been referred to the preve ntion and control on the height of early colorectal cancer.
Objective:Through research and review of clinical data of some colorectal polyps, discussi on on whether gallbladder disease (gallstones, cholecystectomy) and the colorectal polyps we re associated, use the Chinese medicine theory on which the adenoma in patients with physical ty pe, providing a new theoretical basis for the early detection of colorectal polyps in patients with gallbladder disorders and the endoscopic treatment, and also provide the TCM constitutions recu peration basis for the prevention and treatment of colorectal polyps.
Methods:From the January2010to March2012in Jiangsu Province Hospital of Traditiona1Chinese Medicine, Digestive Endoscopy Center out-patient and ward,a total of400patients, ex cluded Inflammatory bowel disease,familial adenomatous polyposis (FAP),Peutz-Jeghers disease, cancer and other diseases by colonoscopy, according to the past with or without a history of cholecystectomy is divided into treatment group (82cases) and c ontrol group (306cases) randomly, analysising of the two groups of patients with colorectal p olyps the incidence of endoscopic the polyps performance and histological type.in addition, ident ificating the physical of74patients with polyp recurrence in these cases according to the TCM c onstitution classification criteria. These are used in Microsoft Excel to establish a database.and to use spss17.0statistical software to analyze.
Results:Cholecystectomy group of colorectal polyps rate was higher than control group (42.7%to27.8%),and it has statistically significant difference (OR=1.936,p=0.01<0.05) Location and morphology of the two groups of patients with polyps were no significant differences (p﹥0.05). However, the risk of adenomatous polyps in patients with cholecystectomy was sig nificantly higher (or=2.729,p=0.028﹤0.05).Also,the survey found that there are several common physical types of adenomatous colorectal polyps:phlegm, damp-heat, blood stasis,Qi stagnation, Qi deficiency, Yang deficiency,Yin deficiency,gentleness and special intrinsic quality.Among these nine types,t here was,31cases of phlegm,25cases of damp-heat,4cases of blood stasis,3cases of qi stagnati on,5cases of qi deficiency,7cases of yang deficiency,0cases of yin deficiency,1case of gentless,1case of special intrinsic quality.
Conclusion:1.The risk of patients with gallbladder disorders getting colorectal polyps has no nec essarily linked to cholecystectomy.
2. The incidence of adenomatous polyps of Cholecystolithiasis was significantly higher;
3. Cholecystolithiasis,Cholecystectomy is one of the risk factors for the incidence of colorec tal polyps;
4. Among those common physical types of adenomatous colorectal, phlegm,damp-heat, sign ificantly higher than other constitutional types, accounting for80%of the patients;
5. Emphasising on screening and monitoring the early colorectal cancer and adenomatous p olyps of patients with cholecystectomy postoperative is necessary.
目的：通过研究部分结直肠息肉患者的病例资料,探讨胆囊疾患(胆囊结石、胆囊切除)与结直肠息肉是否存在相关性,并运用相关中医理论对其中腺瘤性息肉的患者进行体质分型,为临床上对有胆囊疾患的患者及早发现结直肠息肉并行内镜下治疗提供新的理论依据以及为结直肠息肉的防治提供中医体质学调养依据。
方法：收集2010年1月—2012年03月期间于江苏省中医院消化内镜中心门诊及病房行肠镜检查的部分患者400例,经结肠镜检查排除炎症性肠病、家族性腺瘤性息肉病Familial adenomatous polyposis (FAP)、黑斑息肉病(P-J综合征)、恶性肿瘤等疾病的患者388例,根据既往有无胆囊疾患分为胆囊疾患组(n=82)和对照组(n=306),对两组患者结直肠息肉的发生率、内镜下息肉表现和组织学类型进行分析；此外,根据《中医体质分类判定标准》对上述病例中病理类型为腺瘤性息肉的患者74例进行体质辨识,以上均采用Microsoft Excel建立数据库,并使用spssl7.0统计软件进行分析。
结果：胆囊疾患组结直肠息肉发生率高于对照组(42.7%对27.8%),且差异有统计学意义(OR=1.936,p=0.01<0.05)。两组患者息肉的部位无明显差异(P>0.05)；但胆囊切除患者腺瘤性息肉的发生危险显著高于对照组(OR=2.729,P=0.028<0.05)。此外调查还发现,腺瘤性大肠息肉的常见体质类型有痰湿质、湿热质、血瘀质、气郁质、气虚质、阳虚质、阴虚质、平和质、特禀质九种类型,其中痰湿质有31人,占41.89%；湿热质有25人,占33.78%；血瘀质有4人,占5.41%；气郁质有3人,占4.05%；气虚质有2人,占2.70%；阳虚质有7人,占9.46%；阴虚质有0人；平和质有1人,占1.35%；特禀质1人,占1.35%；平和质1人,占1.35%。
结论：1.伴有胆囊疾患的患者与结直肠息肉的关系与是否行胆囊切除并没有必然联系；
2.胆囊切除术后腺瘤性息肉的发生率明显增高；
3.胆囊结石、胆囊切除术是结直肠息肉患者发病的高危因素之一；
4.在腺瘤性结直肠息肉常见体质类型中,痰湿质、湿热质明显高于其他体质类型,约占发病人数的80%。
5.因此重视胆囊切除术后患者的早期结直肠癌和腺瘤性息肉的筛查和监测是非常必要的。
Background:Cholecystolithiasis and Colorectal polyps are both common disease of the dig estive system. Cholecystectomy is one of the main treatment of Cholecystolithiasis. Cholecystoli thiasis, cholecystectomy has been considered one of the risk factors for colorectal cancer, colorec tal polyps, especially adenomas has been recognized as a precancerous lesion of colorectal cance r, but the relationship between cholecystectomy and colorectal polyps has not been taken seriousl y, Therefore, regular follow-up of patients with colorectal polyps have been referred to the preve ntion and control on the height of early colorectal cancer.
Objective:Through research and review of clinical data of some colorectal polyps, discussi on on whether gallbladder disease (gallstones, cholecystectomy) and the colorectal polyps we re associated, use the Chinese medicine theory on which the adenoma in patients with physical ty pe, providing a new theoretical basis for the early detection of colorectal polyps in patients with gallbladder disorders and the endoscopic treatment, and also provide the TCM constitutions recu peration basis for the prevention and treatment of colorectal polyps.
Methods:From the January2010to March2012in Jiangsu Province Hospital of Traditiona1Chinese Medicine, Digestive Endoscopy Center out-patient and ward,a total of400patients, ex cluded Inflammatory bowel disease,familial adenomatous polyposis (FAP),Peutz-Jeghers disease, cancer and other diseases by colonoscopy, according to the past with or without a history of cholecystectomy is divided into treatment group (82cases) and c ontrol group (306cases) randomly, analysising of the two groups of patients with colorectal p olyps the incidence of endoscopic the polyps performance and histological type.in addition, ident ificating the physical of74patients with polyp recurrence in these cases according to the TCM c onstitution classification criteria. These are used in Microsoft Excel to establish a database.and to use spss17.0statistical software to analyze.
Results:Cholecystectomy group of colorectal polyps rate was higher than control group (42.7%to27.8%),and it has statistically significant difference (OR=1.936,p=0.01<0.05) Location and morphology of the two groups of patients with polyps were no significant differences (p﹥0.05). However, the risk of adenomatous polyps in patients with cholecystectomy was sig nificantly higher (or=2.729,p=0.028﹤0.05).Also,the survey found that there are several common physical types of adenomatous colorectal polyps:phlegm, damp-heat, blood stasis,Qi stagnation, Qi deficiency, Yang deficiency,Yin deficiency,gentleness and special intrinsic quality.Among these nine types,t here was,31cases of phlegm,25cases of damp-heat,4cases of blood stasis,3cases of qi stagnati on,5cases of qi deficiency,7cases of yang deficiency,0cases of yin deficiency,1case of gentless,1case of special intrinsic quality.
Conclusion:1.The risk of patients with gallbladder disorders getting colorectal polyps has no nec essarily linked to cholecystectomy.
2. The incidence of adenomatous polyps of Cholecystolithiasis was significantly higher;
3. Cholecystolithiasis,Cholecystectomy is one of the risk factors for the incidence of colorec tal polyps;
4. Among those common physical types of adenomatous colorectal, phlegm,damp-heat, sign ificantly higher than other constitutional types, accounting for80%of the patients;
5. Emphasising on screening and monitoring the early colorectal cancer and adenomatous p olyps of patients with cholecystectomy postoperative is necessary.
引文
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