摘要
目的 分析中老年男性保健人群长期肠镜随访过程中结直肠息肉再检出情况的动态变化趋势.方法 回顾性分析解放军总医院1983年4月至2013年4月初次肠镜检出息肉后长期随访的中老年男性保健人群,收集其一般临床资料、结直肠镜报告、病理报告.采用单因素重复测量方法分析息肉初次检出情况,随访中息肉数量、大小、病理类型及不同部位分布的变化规律.结果 共收集至少有5年结直肠镜随访的501例中老年男性保健人群的3 746例次肠镜检查结果;年龄50~99岁,平均（74±9）岁;行结肠镜检查初次发现息肉时的平均年龄（66±8）岁,随访54～348个月,平均（157±80）个月.分别有501、371、251、106例随访至第5、10、15、20年;每例平均随访（7±5）次.共检出息肉9 006枚,3 986枚取得病理,其中腺瘤性息肉共2 608枚（65.43%）;直肠、降结肠及乙状结肠共4 638枚（51.50%）,升结肠、回盲部及盲肠共1 314枚（14.59%）.随访第5、10、15、20年息肉检出的大小均小于初次检出[（0.07±0.01）、（0.07±0.01）、（0.12±0.03）、（0.07±0.01）比（0.44±0.03）cm,均P〈0.05],第5、10、20年息肉检出数均少于初次检出[（0.77±0.09）、（0.83±0.10）、（1.03±0.20） 比（3.08±0.19）枚,均P＜0.05].各病理类型的息肉在随访不同年限检出的数目不同（P＜0.05）,在随访的第2、5、7、10、11、15、18、19年息肉数目呈现检出高峰,管状腺瘤息肉检出数目高于管状绒毛状、炎性息肉和增生性息肉（均P＜0.05）.各部位结肠息肉在不同随访年限检出的数目不同（P＜0.05）,但不同部位检出数目的 变化趋势不同.结论 中老年男性保健人群首次结直肠镜检出息肉的平均年龄为66岁,其病理类型以腺瘤性息肉为主,息肉分布主要集中在左半结肠.肠镜随访中检出息肉的大小及数目均呈下降趋势,但息肉数目有随年龄变化趋势;随访中息肉的检出存在解剖部位及组织病理学差异.
Objective To analyze the trends of colorectal polyps for age ≥50 years male healthcare patients during a long-term colonoscopic follow-up. Methods Endoscopic and pathological reports of age ≥ 50 years male healthcare patients undergoing colonoscopy from April 1983 to April 2013 were retrospectively reviewed and their general data collected. The proportion of different histological types, the distribution at different anatomic sites and the trends of size and number of colorectal polyps during different follow-up years were analyzed. Results A total of 3 746 colonoscopy reports of 501 age ≥ 50 years healthcare cases were collected. After initial colonoscopic screening and polypectomy,501,371,251 and 106 cases were followed up to the 5th, 10th, 15th and 20th years. Their mean age was （ 74 ± 9 ） years. And their mean age of initial colonoscopic screening and polypectomy was （66 ± 8） years. During a follow-up period of 54 - 348 months, each of them underwent （7 ± 5 ）colonoscopies. A total of 9 006 polyps were detected and 3 986 polyps confirmed pathologically. And 2 608 polyps （65.43%） belonged to adenomas. Among them, 4 638 （51.50%） polyps were located in descending colon and rectum while 1 314 （14. 59% ） in ascending colon and cecum. In a descending trend, the sizes of initial colonoscopy, 5th, 10th, 15th and 20th year were 0.44 ± 0.03,0. 07 ±0. 01,0. 07 ±0.01,0. 12 ±0.03 and 0. 07 ±0. 01 respectively during the follow-up period （ all P 〈0.05）. Also the numbers were in a descending trend, initial colonoscopy, 5th, 10th and 20th year were 3.08 ±0. 19,0.77 ±0.09,0. 83 ± 0. 10 and 1.03 ± 0. 20 respectively during the follow-up period （all P 〈 0. 05）. The numbers of four different pathological types of polyps were all in a descending trend compared with initial colouoscopy. And the numbers peaked around 2nd ,5th ,7th , 10th , 11th, 15th, 18th and 19th year of follow-up. Statistical differences existed between tubular adenoma and tubule-villous adenoma, inflammatory polyps and hyperplastic polyps in mean number in the same follow-up year（ all P 〈 0. 05 ）. The number of colorectal polyps in different anatomic sites was different in the same follow-up year （all P 〈 0.05）. Conclusions The mean age of initial colonoscopic screening and polypectomy is 66 years. And the main histological type of colorectal polyps is adenoma. Rectum, sigmoid and descending colon are the major sites of colorectal polyps. During the follow-up, the size and number of colorectal polyps are both in a descending trend and the number changes with years. The recurrence of colorectal polyps has pathological and anatomical disparities during follow-up years.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2014年第6期433-437,共5页
National Medical Journal of China
关键词
老年人
综合保健
肠息肉
随访研究
Aged
Comprehensive health care
Intestinal polyps
Follow-up studies
