Colonic adenomas--a colonoscopy survey.
Colonic adenomas--a colonoscopy survey.
复制标题
结肠腺瘤——结肠镜检查。
作者：
P. Gillespie;T. J. Chambers;K. Chan;F. Doronzo;B. Morson;C. Williams
对620例患者的1049个结肠腺瘤的结肠镜检查显示，腺瘤主要分布在左侧(77%)。在这些病变中，97%的病变可以接受内窥镜切除或消融。60%的患者以直肠出血为主要症状。放射学和结肠镜检查之间只有62%的患者符合，因为许多研究都是在转诊前进行的单对比钡灌肠检查。本组病例中，48%的腺瘤直径小于1.0 cm。在较大的腺瘤(直径>2.0 cm)中，66%位于乙状结肠，而在浸润性癌中，乙状结肠癌和低位降结肠的比例更高(94%)。随着息肉大小的增加，绒毛成分占优势，与更常见且通常较小的管状腺瘤相比，这与恶变的风险更高有关。局部结肠镜切除对于腺瘤的恶变是足够的，除非它们在组织学上分化较差，并且有足够的切除证明。用这种方法治疗的28名患者在6到62个月的时间里没有复发。虽然65%的患者只有一个腺瘤，90%的患者只有三个或更少的腺瘤，但仍有发生其他良性和恶性结肠癌的风险，需要仔细随访。
A colonoscopy survey of 620 patients with 1049 colon adenomas showed a predominantly left-sided distribution (77%). Of these lesions 97% were amenable to endoscopic removal or ablation. Sixty per cent of patients presented with rectal bleeding as their major symptom. There was agreement between radiology and colonoscopy in only 62% of patients, as many of the studies were single contrast barium enemas, performed before referral. Forty-eight per cent of adenomas in our series were less than 1.0 cm in diameter. Of the larger adenomas (greater than 2.0 cm in diameter) 66% were situated in the sigmoid colon, and of those containing invasive carcinoma (4.8% of the total) an even higher percentage (94%) were in the sigmoid and low descending colon. With increasing polyp size, there was a greater predominance of villous elements and this was associated with a higher risk of malignant change than the more frequent and generally smaller tubular adenoma. Local colonoscopic excision alone is sufficient treatment for adenomas with malignant change unless they are poorly differentiated histologically and providing adequate resection is demonstrated. Twenty-eight patients treated in this way are alive without recurrence at periods from six to 62 months. Although 65% of patients had only one adenoma, and 90% three or less, there is a risk of developing other benign and malignant colon neoplasms and careful follow-up is required.