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目的 :研究大肠“高危腺瘤”的构成 ,肠段分布及高危因素的特点 ,以有助于腺瘤癌变的早期防治。方法 :经大肠镜检发现大肠腺瘤患者 2 5 8例 ,详细记录腺瘤部位、大小、形态、并送活检。有下述三项高危因素之一腺瘤为“高危腺瘤”包括 :腺瘤大于 2 0mm绒毛状腺瘤 ;伴有中、重度异型增生的腺瘤。大部分腺瘤经高频电切术切除并送全瘤病理。有 5 1例患者行潜血检测。结果 :2 5 8例患者共检出腺瘤 30 8枚 ,其中“高危腺瘤”132枚。具有上述单项、双项及三项高危险因素素腺瘤数分别 2 3、99、10枚 ,各占“高危腺瘤”总数的 17.4 % ,75 .0 % ,7.6 %。“高危腺瘤”数分布以直肠、乙状结肠为最多 (占 72 % ) ,自远段向近段递减。其中同时具有三项高危险因素的 10枚腺瘤的分布为直肠 4枚 ,乙状结肠 3枚 ,降结肠 3枚。 5 1例便潜血检测可见“高危腺瘤”显性血便及便潜血阳性率均明显高于非“高危腺瘤”(P <0 .0 5 )。结论 :“高危腺瘤”指有高度恶变倾向的腺瘤 ,其构成包括 :腺瘤大于 2 0mm ,绒毛状腺瘤 ,伴有中、重度异型增生的腺瘤。具有多项危险因素的腺瘤可能具有更强的恶变趋向性 ;“高危腺瘤”经内镜切除后复发出现“高危腺瘤”或癌变的机率显著高于原先无高危因素者 ,说明“高危腺瘤”摘除术后随诊甚为重要
Objective: To study the constitution of high-risk adenoma of the large intestine, the distribution of intestinal segments and the characteristics of high risk factors so as to contribute to the early prevention and treatment of adenoma. Methods: A total of 258 patients with colorectal adenomas were examined by colonoscopy. The adenoma site, size and shape were recorded in detail and submitted to biopsy. One of the following three risk factors for adenoma as “high-risk adenoma” include: adenoma> 20mm villous adenoma; accompanied by moderate and severe dysplasia adenoma. Most of the adenomas were excised by high-frequency electrotomy and sent for pathology. 51 cases of patients with occult blood test. Results: A total of 288 adenomas were detected in 258 cases, of which 132 were high-risk adenomas. The number of adenomas with single, dual and three high risk factors mentioned above was 23,99 and 10, accounting for 17.4%, 75.0% and 7.6% of the total. The distribution of “high-risk adenomas” was mostly in the rectum and sigmoid colon (72%), decreasing from the distal segment to the proximal segment. The distribution of 10 adenomas with three high risk factors was 4 in the rectum, 3 in the sigmoid colon and 3 in the descending colon. 51 cases of occult blood test shows that “high-risk adenoma” was significantly higher than the bloody stool and occult blood positive rate was higher than non-“high-risk adenoma” (P <0.05). Conclusions: “High-risk adenoma” refers to adenomas with a high tendency to malignant transformation. Its composition includes adenomas with a diameter of more than 20 mm, villous adenoma, and adenomas with moderate and severe dysplasia. Adenomas with multiple risk factors may have more malignant tendency; “high-risk adenomas” after endoscopic resection “high-risk adenoma” or cancer was significantly higher than the previously no risk factors, indicating that “high risk Adenoma ”follow-up after enucleation is very important