【摘要】：目的:研究顆粒型結(jié)直腸側(cè)向發(fā)育型腫瘤(granular colorectal laterally spreading tumor,LST-G)的臨床病理學(xué)特點(diǎn),分析LST-G的癌變相關(guān)危險(xiǎn)因素,為臨床診療提供指導(dǎo)及參考。方法:對(duì)2013年10月至2016年11月間在大連醫(yī)科大學(xué)附屬第一醫(yī)院診治的65例LST-G患者資料進(jìn)行回顧性研究,所有患者均行內(nèi)鏡下黏膜切除術(shù)(EMR)或內(nèi)鏡黏膜下剝離術(shù)(ESD)治療,分析其癌變率�；颊叩囊话闩R床資料包括年齡、性別、腸癌家族史、有無吸煙及飲酒史;患者的LST-G病變性狀特征包括病變的直徑大小、病變表面結(jié)節(jié)大小(指最大結(jié)節(jié)或主要結(jié)節(jié)的大小)及部位�？ǚ綑z驗(yàn)或t檢驗(yàn)分析出可能的危險(xiǎn)因素,多因素Logistic回歸分析引起癌變的獨(dú)立危險(xiǎn)因素。結(jié)果:1.共有65例LST-G納入研究,其中33例發(fā)生癌變(50.8%),32例為非癌變(49.2%)。2.一般臨床資料比較:癌變組和非癌變組間年齡(p=0.595)、性別(p=0.089)、有無吸煙史(p=0.063)、有無飲酒史(p=0.097)均無明顯差異;有結(jié)腸癌家族史的患者癌變率(83.3%)顯著高于無結(jié)腸癌家族史的患者(43.4%)(p=0.029)。3.病變的性狀特征比較:癌變組和非癌變組間在病變部位(p=0.103)方面無顯著性差異;癌變組的病變直徑(26.3±9.8mm)明顯高于非癌變組(19.8±6.8mmm)(p=0.003),且直徑分組間有顯著性差異(p=0.001);癌變組的LST-G表面結(jié)節(jié)(指最大結(jié)節(jié)或主要結(jié)節(jié))直徑明顯大于非癌變組(p0.001);4.多因素Logistic回歸分析顯示,LST-G發(fā)生癌變的獨(dú)立危險(xiǎn)因素為:病變直徑分組(p=0.034)、結(jié)節(jié)直徑分組(p0.001)以及是否有腸癌家族史(p=0.026),其OR值順序?yàn)?結(jié)節(jié)直徑分組(29.722)腸癌家族史(17.090)病變直徑分組(0.034)。結(jié)論:1.患者的一般臨床資料中:年齡、性別、有無吸煙史及有無飲酒史與LST-G癌變無關(guān);結(jié)腸癌家族史是LST-G發(fā)生癌變的危險(xiǎn)因素。2.LST-G病變的性狀特征中:病變部位與LST-G發(fā)生癌變無明顯相關(guān)性;病變的直徑、病變表面結(jié)節(jié)的直徑均為L(zhǎng)ST-G發(fā)生癌變的危險(xiǎn)因素。3.多因素Logistic回歸分析顯示:病變表面結(jié)節(jié)(指最大結(jié)節(jié)或主要結(jié)節(jié))直徑比腸癌家族史及病變直徑對(duì)LST-G是否癌變具有更高的預(yù)測(cè)價(jià)值,即結(jié)節(jié)直徑越大,LST-G的癌變率越高。
[Abstract]:Objective: to study the clinicopathological characteristics of granular colorectal lateral development tumor (granular colorectal laterally spreading tumor,LST-G) and to analyze the risk factors of LST-G carcinogenesis, and to provide guidance and reference for clinical diagnosis and treatment. Methods: from October 2013 to November 2016, the data of 65 patients with LST-G in the first affiliated Hospital of Dalian Medical University were retrospectively studied. All patients were treated with endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). The general clinical data of the patients included age, sex, family history of bowel cancer, history of smoking and drinking. The pathological characteristics of LST-G include the diameter of the lesion, the size of the lesion surface (the size of the largest or main nodule) and the location of the lesion. The possible risk factors were analyzed by chi-square test or t test, and the independent risk factors of carcinogenesis were analyzed by multivariate Logistic regression analysis. Results: 1. A total of 65 cases of LST-G were included in the study, of which 33 cases (50.8%) developed carcinogenesis and 32 cases (49.2%) were non-cancerous. There were no significant differences in age, sex (p0.089), smoking history (p0.063) and drinking history (p0.097) between cancerous group and non-cancerous group (p0. 595), sex (p0. 089), smoking history (p0. 063) and drinking history (p0. 097). The incidence of cancer in patients with family history of colon cancer (83.3%) was significantly higher than that in patients without family history of colon cancer (43.4%) (p 0.029). There was no significant difference between the canceration group and the non-cancerous group in the location of lesion (p0. 103). The diameter of lesion in cancer group (26. 3 鹵9.8mm) was significantly higher than that in non cancerous group (19. 8 鹵6.8mmm) (p0. 003), and there was significant difference in diameter between groups (p0. 001). The diameter of LST-G surface nodules in carcinogenesis group was significantly larger than that in non-cancerous group (P 0. 001). Multivariate Logistic regression analysis showed that the independent risk factors for carcinogenesis in LST-G were as follows: lesion diameter group (p0. 034), nodular diameter group (p0. 001), and family history of colorectal cancer (p0. 026). The order of OR was: nodular diameter group (29.722), colorectal cancer family history (17.090), lesion diameter group (0.034). Conclusion: 1. Age, sex, smoking history and drinking history were not associated with LST-G carcinogenesis. The family history of colon cancer was the risk factor of carcinogenesis in LST-G. There was no significant correlation between the location of lesion and the carcinogenesis of LST-G in 2.LST-G. The diameter of lesion and the diameter of lesion surface were all risk factors for carcinogenesis of LST-G. Multivariate Logistic regression analysis showed that the diameter of the lesion surface nodules (the largest or the main nodules) had a higher predictive value for the carcinogenesis of LST-G than the family history of colorectal cancer and the diameter of the lesions, that is, the larger the diameter of the nodules, the greater the diameter of the nodules. The higher the canceration rate of LST-G.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.34
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本文編號(hào)：2359750