内镜下治疗大肠息肉并发出血的危险因素以及腺瘤性息肉的癌变特征分析
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摘要
目的该研究目的是认识直径≥1.0 cm大肠息肉临床特点、内镜下治疗出血的危险因素及腺瘤性息肉癌变的特征分析。方法回顾该院2014年1月1日-2016年1月1日经内镜下切除的直径≥1.0 cm大肠息肉741例患者,共884枚息肉;分析患者的临床资料、内镜下特点、息肉切除出血危险因素及腺瘤性息肉癌变的特征。结果大肠息肉内镜下切除术术中、迟发性出血的单因素分析中,发现性别(P=0.017)、息肉部位(P=0.011)、息肉大小(P=0.004)、表面是否分叶(P=0.010)、内镜手术方式(P=0.029)在两组间差异有统计学意义;以息肉为观察单位,对患者临床资料和内镜下特点进行Logistic回归多因素分析时,发现性别(P=0.012,OR=2.671,95%CI=1.246~5.728)为独立危险因素,男性比女性更易发生出血;息肉部位为乙状结肠相对于直肠来讲为保护因素(P=0.011,OR=0.348,95%CI=0.154~0.786),息肉大小≥3.0 cm相对于息肉大小为1.0~1.9 cm来讲为危险因素(P=0.049,OR=2.530,95%CI=1.005~6.374)。大肠腺瘤性息肉癌变特征单因素分析时,发现表面是否分叶(P=0.001)、是否光滑(P=0.017)、山田分型(P=0.008)在两组间差异有统计学意义,进行Logistic回归分析多因素时,得出表面分叶(P=0.001,OR=6.556,95%CI=2.326~18.475)是腺瘤性息肉癌变的独立危险因素。结论内镜下治疗大肠息肉是一种安全的治疗方法 ;以息肉为观察单位,性别为大肠息肉内镜下切除术术中、迟发性出血的独立危险因素,男性比女性更易发生出血;息肉直径越大,发生出血的可能性越大;表面分叶的大肠腺瘤性息肉提示癌变的可能性大。
Objective To investigate the clinical data, risk factors for bleeding following endoscopic treatment of colorectal polyps(diameter ≥ 1.0 cm) and feature analysis for carcinogenesis of adenomatous polyps. Method It was analyzed retrospectively that the clinical data, endoscopic characteristics, risk factors for bleeding and features for carcinogenesis of adenomatous polyps in 741 patients with a total of 884 colorectal polyps(diameter ≥ 1.0 cm) of our hospital from January 1, 2014 to January 1, 2016, which were resected under endoscope. Result Univariate analysis of colorectal polyps resected under endoscope on intraoperative and delayed bleeding, we found that gender(P = 0.017), location(P = 0.011), size(P = 0.004), lobulated or not(P = 0.010), resection methods under endoscope(P = 0.029) were statistically significant deviation between the two groups; taking the polyp as observation unit, multivariate Logistic regression analysis of their clinical data and endoscopic characteristics, we found gender(P = 0.012, OR = 2.671, 95% CI = 1.246 ~ 5.728) was an independent risk factor, men are more prone to bleeding than women; it was a protective factor for the location of polyps is sigmoid colon compared to rectum(P = 0.011, OR = 0.348, 95% CI = 0.154 ~ 0.786), and it was a risk factor for the polyps whose diameters ≥ 3.0 cm compared to among 1.0 ~ 1.9 cm. Univariate analysis of the features for carcinogenesis of colorectal adenomatous polyps, we found that surface lobulated or not(P = 0.001), surface smooth or not(P = 0.017), Yamada classification(P = 0.008) were statistically significant deviation, and the logistic regression analysis identified surface lobulation(P = 0.001, OR = 6.556, 95% CI = 2.326 ~ 18.475) was an independent risk factor for carcinogenesis of adenomatous polyps. Conclusion Resection of colorectal polyps under endoscope is a safe treatment method. Taking the polyp as observation unit, gender is an independent risk factor of colorectal polyps resected under endoscope on intraoperative and delayed bleeding, men are more prone to bleeding than women; the larger the diameters of polyps are, the higher the bleeding rates could be. Surface lobulation of colorectal adenomatous polyps are more likely lead to carcinogenesis.
Objective To investigate the clinical data, risk factors for bleeding following endoscopic treatment of colorectal polyps(diameter ≥ 1.0 cm) and feature analysis for carcinogenesis of adenomatous polyps. Method It was analyzed retrospectively that the clinical data, endoscopic characteristics, risk factors for bleeding and features for carcinogenesis of adenomatous polyps in 741 patients with a total of 884 colorectal polyps(diameter ≥ 1.0 cm) of our hospital from January 1, 2014 to January 1, 2016, which were resected under endoscope. Result Univariate analysis of colorectal polyps resected under endoscope on intraoperative and delayed bleeding, we found that gender(P = 0.017), location(P = 0.011), size(P = 0.004), lobulated or not(P = 0.010), resection methods under endoscope(P = 0.029) were statistically significant deviation between the two groups; taking the polyp as observation unit, multivariate Logistic regression analysis of their clinical data and endoscopic characteristics, we found gender(P = 0.012, OR = 2.671, 95% CI = 1.246 ~ 5.728) was an independent risk factor, men are more prone to bleeding than women; it was a protective factor for the location of polyps is sigmoid colon compared to rectum(P = 0.011, OR = 0.348, 95% CI = 0.154 ~ 0.786), and it was a risk factor for the polyps whose diameters ≥ 3.0 cm compared to among 1.0 ~ 1.9 cm. Univariate analysis of the features for carcinogenesis of colorectal adenomatous polyps, we found that surface lobulated or not(P = 0.001), surface smooth or not(P = 0.017), Yamada classification(P = 0.008) were statistically significant deviation, and the logistic regression analysis identified surface lobulation(P = 0.001, OR = 6.556, 95% CI = 2.326 ~ 18.475) was an independent risk factor for carcinogenesis of adenomatous polyps. Conclusion Resection of colorectal polyps under endoscope is a safe treatment method. Taking the polyp as observation unit, gender is an independent risk factor of colorectal polyps resected under endoscope on intraoperative and delayed bleeding, men are more prone to bleeding than women; the larger the diameters of polyps are, the higher the bleeding rates could be. Surface lobulation of colorectal adenomatous polyps are more likely lead to carcinogenesis.
引文
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[18]赵颖,王玉芳,王维.大肠息肉的临床、病理及内镜特征[J].四川医学,2002,23(1):17-18.[18]ZHAO Y,WANG Y F,WANG W.Colorectal polyp:clinical,pathologic and endoscopic features[J].Sichuan Medical Journal,2002,23(1):17-18.Chinese
[19]武和平,李萍,郑昱.1032例大肠息肉治疗探讨[J].中华消化杂志,2005,25(6):374.[19]WU H P,LI P,ZHENG Y.Discussion on the treatment of 1032cases of colorectal polyp[J].Chinese Journal of Digestion,2005,25(6):374.Chinese
[20]席利力,谢会忠,古丽巴哈尔·司马义.1232例大肠息肉癌变相关因素分析[J].中华消化内镜杂志,2009,26(4):215-216.[20]XI L L,XIE H Z,GULIBAHAER S M Y.Analysis of the related factors of 1232 cases of colorectal polyp[J].Chinese Journal of Digestive Endoscopy,2009,26(4):215-216.Chinese
[21]CHEN H,LEFFERTS J A,SCHWAB M C,et al.Correlation of polypoid colorectal adenocarcinoma with pre-existing adenomatous polyps and KRAS mutation[J].Cancer Genet,2011,204(5):245-251.
[2]ZAUBER A G,WINAWER S J,O’BRIEN M J,et al.Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths[J].N Engl J Med,2012,366(8):687-696.
[3]DOBROWOLSKI S,DOBOSZ M,BABICKI A,et al.Blood supply of colorectal polyps correlates with risk of bleeding after colonoscopic polypectomy[J].Gastrointest Endosc,2006,63(7):1004-1009.
[4]PASPATIS G A,TRIBONIAS G,KONSTANTINIDIS K,et al.A prospective randomized comparison of cold vs hot snare polypectomy in the occurrence of postpolypectomy bleeding in small colonic polyps[J].Colorectal Dis,2011,13(10):e345-e348.
[5]黄丽韫,毛华,金少琴,等.大肠息肉切除术后迟发性出血的危险因素分析[J].中国内镜杂志,2012,18(8):809-812.[5]HUANG L Y,MAO H,JIN S Q,et al.Risk factors of delayed postpolypectomy bleeding[J].China Journal of Endoscopy,2012,18(8):809-812.Chinese
[6]毛华,金少琴.内镜下大肠息肉切除术后出血的防治[J].中国内镜杂志,2012,18(10):1058-1062.[6]MAO H,JIN S Q.Prevention and treatment of bleeding after endoscopic resection of colorectal polyps[J].China Journal of Endoscopy,2012,18(10):1058-1062.Chinese
[7]陆小锋,林细州,郑亮,等.山田分型法应用于内镜下大肠息肉摘除术的回顾性研究[J].中国内镜杂志,2015,21(8):836-839.[7]LU X F,LIN X Z,ZHENG L,et al.Research of Yamada classification guidance for endoscopic polypectomy of large intestine[J].China Journal of Endoscopy,2015,21(8):836-839.Chinese
[8]WATABE H,YAMAJI Y,OKAMOTO M,et al.Risk assessment for delayed hemorrhagic complication of colonic polypectomy:polyprelated factors and patient-related factors[J].Gastrointest Endosc,2006,64(1):73-78.
[9]CHOO W K,SUBHANI J.Complication rates of colonic polypectomy in relation to polyp characteristics and techniques:a district hospital experience[J].J Interv Gastroenterol,2012,2(1):8-11.
[10]M?NKEMüLLER K,NEUMANN H,MALFERTHEINER P,et al.Advanced colon polypectomy[J].Clin Gastroenterol Hepatol,2009,7(6):641-652.
[11]BUDDINGH K T,HERNGREEN T,HARINGSMA J,et al.Location in the right hemi-colon is an independent risk factor for delayed post-polypectomy hemorrhage:a multi-center casecontrol study[J].Am J Gastroenterol,2011,106(6):1119-1124.
[12]MOON H S,PARK S W,KIM D H,et al.Only the size of resected polyps is an independent risk factor for delayed postpolypectomy hemorrhage:a 10-year single-center case-control study[J].Ann Coloproctol,2014,30(4):182-185.
[13]谢华平,侯伟,赵秋.结直肠息肉切除术后迟发性出血的危险因素[J].世界华人消化杂志,2015,23(3):486-490.[13]XIE H P,HOU W,ZHAO Q.Risk factors for delayed postpolypectomy bleeding[J].World Chinese Journal of Digestology,2015,23(3):486-490.Chinese
[14]MORSON B C.Genesis of colorectal cancer[J].Clin Gastroenterol,1976,5(3):505-525.
[15]舒晴,赵素芳,焦璐,等.结肠息肉癌变的相关危险因素及内镜治疗随访结果分析[J].现代消化及介入诊疗,2016,21(1):24-27.[15]SHU Q,ZHAO S F,JIAO L,et al.Analysis of the risk factors and the effect of endoscopy for the colorectal polyp cancerization[J].Modern Digestion&Intervention,2016,21(1):24-27.Chinese
[16]王水红,马应杰.大肠腺瘤性息肉临床病理特点及癌变相关因素分析[J].中华实用诊断与治疗杂志,2010,24(4):393-395.[16]WANG S H,MA Y J.Clinicopathological Features and correlation analysis of carcinogenesis of colorectal adenomatous polyp[J].Journal of Chinese Practical Diagnosis and Therapy,2010,24(4):393-395.Chinese
[17]RISIO M.The natural history of colorectal adenomas and early cancer[J].Pathologe,2012,33(Suppl 2):206-210.
[18]赵颖,王玉芳,王维.大肠息肉的临床、病理及内镜特征[J].四川医学,2002,23(1):17-18.[18]ZHAO Y,WANG Y F,WANG W.Colorectal polyp:clinical,pathologic and endoscopic features[J].Sichuan Medical Journal,2002,23(1):17-18.Chinese
[19]武和平,李萍,郑昱.1032例大肠息肉治疗探讨[J].中华消化杂志,2005,25(6):374.[19]WU H P,LI P,ZHENG Y.Discussion on the treatment of 1032cases of colorectal polyp[J].Chinese Journal of Digestion,2005,25(6):374.Chinese
[20]席利力,谢会忠,古丽巴哈尔·司马义.1232例大肠息肉癌变相关因素分析[J].中华消化内镜杂志,2009,26(4):215-216.[20]XI L L,XIE H Z,GULIBAHAER S M Y.Analysis of the related factors of 1232 cases of colorectal polyp[J].Chinese Journal of Digestive Endoscopy,2009,26(4):215-216.Chinese
[21]CHEN H,LEFFERTS J A,SCHWAB M C,et al.Correlation of polypoid colorectal adenocarcinoma with pre-existing adenomatous polyps and KRAS mutation[J].Cancer Genet,2011,204(5):245-251.