Frequency and severity of ileal adenomas in familial adenomatous polyposis after colectomy
Frequency and severity of ileal adenomas in familial adenomatous polyposis after colectomy
复制标题
DOI：
10.1055/s-2007-995363
复制
发表时间：
2008-02-01
期刊：
影响因子：
9.3
通讯作者：
Saurin, J. C.
中科院分区：
文献类型：
--
作者：
Moussata, D.;Nancey, S.;Saurin, J. C.
背景和研究目的：家族性腺瘤性息肉病（FAP）患者结直肠癌的高累积风险证明了预防性结肠切除术与回肠直肠（伊拉）或回肠袋肛门吻合术（IPAA）的合理性。我们的目的是回顾性评估的频率和时间间隔腺瘤发展的患者在回肠粘膜的两种类型surgery.Patients和方法：回顾性研究44例FAP患者与伊拉（n = 21）和IPAA（n = 23）。所有患者均接受标准化程序随访，包括色素镜检查和可见息肉的活检。在伊拉患者中，特别注意吻合口上方的回肠粘膜。结果：在IPAA组中，18/23例患者（78%）出现可见息肉[组织学：16例（70%）患有腺瘤伴低度异型增生; 1例（4%）患有腺瘤伴高度异型增生; 1例正常粘膜]。结肠切除术和腺瘤诊断之间的平均间隔为4.7 ± 3.3年。在伊拉组中，16/21例患者（77%）在回肠粘膜中出现可见的息肉[8例患者（38%）为腺瘤伴低度异型增生，2例患者（10%）为高度异型增生，6例患者为淋巴结结节性增生]。IPAA组结肠切除术和腺瘤诊断之间的平均间隔时间明显短于伊拉组（4.76 ± 3.3 vs. 16.4 ± 8.5年，P < 0.0001）。IPAA和伊拉（分别为74%和48%），6.7%的病例演变为高度异型增生。
Background and study aims: The high cumulative risk of colorectal cancer in patients with familial adenomatous polyposis (FAP) justifies prophylactic colectomy with either ileorectal (IRA) or ileal-pouch-anal anastomosis (IPAA). Our aim was to evaluate retrospectively the frequency of and time interval to adenoma development in the ileal mucosa of patients with both types of surgery.Patients and methods: Retrospective study of 44 FAP patients with IRA (n = 21) and IPAA (n = 23). All patients were followed with a standardized procedure including chromoscopy and biopsies of visible polyps. In patients with IRA, specific attention was paid to the ileal mucosa above the anastomosis.Results: In the IPAA group, 18/23 patients (78%) presented with visible polyps [histology: 16 (70%) had adenoma with low-grade dysplasia; 1 (4%) had adenoma with high-grade dysplasia; 1 had normal mucosa]. The mean interval between colectomy and the diagnosis of adenoma was 4.7 +/- 3.3 years. In the IRA group, 16/21 patients (77%) presented visible polyps in the ileal mucosa [adenoma with low-grade dysplasia in 8 patients (38%), with high-grade dysplasia in 2 (10%), and lymphoid nodular hyperplasia in 6]. The mean interval between colectomy and adenoma diagnosis was significantly shorter in the IPAA than in the IRA group (4.76 +/- 3.3 vs. 16.4 +/- 8.5 years, P < 0.0001).Conclusion: Our results show a high frequency of adenomas in the ileal mucosa of patients with. IPAA and IRA (74% and 48% respectively), with evolution into high-grade dysplasia in 6.7% of cases.