本文選題：結(jié)腸息肉　切入點(diǎn)：復(fù)發(fā)　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探究初次腸鏡下息肉特征與復(fù)發(fā)的關(guān)系,及結(jié)腸息肉切除術(shù)后不同時(shí)間段內(nèi)隨訪復(fù)發(fā)情況;并評(píng)估初次行結(jié)腸鏡檢查時(shí)發(fā)現(xiàn)高風(fēng)險(xiǎn)息肉的風(fēng)險(xiǎn)指標(biāo)。方法:對(duì)2008~2016年在青島大學(xué)附屬醫(yī)院行結(jié)腸鏡下息肉切除術(shù)患者的資料進(jìn)行回顧性分析,認(rèn)真記錄患者特征(年齡、性別、吸煙史、體重指數(shù)(BMI,亞洲人標(biāo)準(zhǔn))、一級(jí)親屬患結(jié)腸癌或結(jié)腸息肉的家族史),初次腸鏡下息肉特征(大小、數(shù)目、病理、部位)及隨訪中息肉復(fù)發(fā)情況,利用單因素和多因素Logistic回歸,分析影響息肉復(fù)發(fā)的主要因素;根據(jù)初次結(jié)腸鏡下息肉特征對(duì)患者風(fēng)險(xiǎn)進(jìn)行分層即:無風(fēng)險(xiǎn)組(炎性息肉、增生性息肉)、低風(fēng)險(xiǎn)組(1~2枚直徑1.0 cm的管狀腺瘤)和高風(fēng)險(xiǎn)組(腺瘤數(shù)目≥3枚、直徑≥1.0 cm管狀腺瘤、有25%以上絨毛成分、高級(jí)別上皮內(nèi)瘤變和非浸潤(rùn)癌),三組復(fù)發(fā)率的比較采用卡方檢驗(yàn),并用Kaplan-Meier生存分析法比較高風(fēng)險(xiǎn)組和低風(fēng)險(xiǎn)組患者累計(jì)復(fù)發(fā)風(fēng)險(xiǎn);通過臨床上的風(fēng)險(xiǎn)指標(biāo),包括年齡、性別、家族史、吸煙史、BMI,利用t檢驗(yàn)和卡方檢驗(yàn)預(yù)估患者初次結(jié)腸鏡檢查中存在高風(fēng)險(xiǎn)息肉的風(fēng)險(xiǎn)。結(jié)果:在單因素分析中,患者的年齡≥70歲,息肉的直徑0.5 cm,數(shù)目2枚且散在分布于全結(jié)腸是復(fù)發(fā)的危險(xiǎn)因素(P=0.00),病理類型中,相對(duì)于非浸潤(rùn)癌,非腫瘤性息肉不易復(fù)發(fā)(P=0.00),而管狀腺瘤、管狀絨毛狀腺瘤、腺瘤伴有低級(jí)別、腺瘤伴有高級(jí)別與非浸潤(rùn)癌比較,P值均0.05,無統(tǒng)計(jì)學(xué)意義。在多因素分析中,息肉數(shù)目是復(fù)發(fā)的獨(dú)立危險(xiǎn)因素(OR=2.36,95%CI 1.06-5.25),年齡、息肉直徑和部位在多因素分析中,并非是復(fù)發(fā)的相關(guān)危險(xiǎn)因素;614名患者經(jīng)歷6~87個(gè)月不等隨訪時(shí)間,平均復(fù)發(fā)率為58.6%,在6~24個(gè)月、24~36個(gè)月、36~48個(gè)月、48~87個(gè)月4個(gè)時(shí)間段內(nèi),總體息肉的累計(jì)復(fù)發(fā)率為50.3%、61.7%、70.1%、75.0%;高風(fēng)險(xiǎn)組累計(jì)復(fù)發(fā)率分別為:60.1%、65.7%、80.7%、83.8%;低風(fēng)險(xiǎn)組累計(jì)復(fù)發(fā)率分別為:22.7%、40.0%、53.8%、65.4%。兩組患者復(fù)發(fā)的累計(jì)風(fēng)險(xiǎn)存在差異(c2=17.17,P=0.00)。無風(fēng)險(xiǎn)組和低風(fēng)險(xiǎn)組分別在隨訪的48個(gè)月和36個(gè)月內(nèi)未發(fā)現(xiàn)進(jìn)展期腺瘤,而低風(fēng)險(xiǎn)組在隨訪的41個(gè)月發(fā)現(xiàn)一例息肉伴部分惡變,無風(fēng)險(xiǎn)組在隨訪中未發(fā)現(xiàn)結(jié)腸癌;高風(fēng)險(xiǎn)組在24個(gè)月發(fā)現(xiàn)4.1%(11/271)的進(jìn)展期腺瘤(主要為直徑≥1.0 cm管狀腺瘤或含有絨毛成分),在隨訪的57個(gè)月和87個(gè)月發(fā)現(xiàn)2例浸潤(rùn)癌�；颊叩哪挲g、性別(男性)、吸煙史(既往吸煙和現(xiàn)在吸煙史)、BMI(≥23kg/m2)、家族史(一級(jí)親屬患結(jié)腸癌、結(jié)腸息肉史)(P0.05),可以預(yù)估患者存在高風(fēng)險(xiǎn)息肉的風(fēng)險(xiǎn)。年齡60歲、男性、有結(jié)腸癌、結(jié)腸息肉家族史,具有吸煙史的患者和超重患者在初次結(jié)腸鏡檢查中更容易發(fā)現(xiàn)高風(fēng)險(xiǎn)息肉。結(jié)論:1.初次結(jié)腸鏡檢查中,年齡、息肉的直徑、數(shù)目、和散在分布于全結(jié)腸是復(fù)發(fā)的相關(guān)因素,其中數(shù)目是復(fù)發(fā)的獨(dú)立危險(xiǎn)因素,非腫瘤性息肉與其它病理類型比較不易復(fù)發(fā)。2.息肉的復(fù)發(fā)率隨時(shí)間延長(zhǎng)而增加,高風(fēng)險(xiǎn)組患者在息肉切除術(shù)后累計(jì)復(fù)發(fā)率高于低風(fēng)險(xiǎn)組患者。對(duì)于高風(fēng)險(xiǎn)組患者內(nèi)鏡下息肉切除術(shù)后的隨訪不應(yīng)超過2年,低風(fēng)險(xiǎn)組可在3年左右,無風(fēng)險(xiǎn)組可延長(zhǎng)至4年隨訪是安全的。3.年齡、性別、吸煙史、體重指數(shù)、家族史均與初次結(jié)腸鏡檢查中發(fā)現(xiàn)高風(fēng)險(xiǎn)息肉具有相關(guān)性。
[Abstract]:Objective: To explore the relationship between the characteristics and the recurrence of polyps of the first colonoscopy, and after resection of colonic polyps in different time recurrence condition; and to evaluate the initial colonoscopy found risk index high-risk polyps. Methods: 2008~2016 in Affiliated Hospital of Qiingdao University underwent colonoscopy polypectomy patients were retrospectively analysis of carefully recorded patient characteristics (age, gender, smoking history, body mass index (BMI, Asian standard), family history of first-degree relatives of colon cancer or colon polyps), initial colonoscopy polyp characteristics (size, number, pathology, location) polyp recurrence and follow-up, using single factor and multiple Logistic regression analysis, the main factors affecting the recurrence; risk stratification of patients according to characteristics of the initial polyp colonoscopy: no risk group (inflammatory polyps, hyperplastic polyps), low risk group (1~2 gold straight A diameter of 1 cm tubular adenoma) and high risk group (adenoma number 3, with diameter larger than 1 cm tubular adenoma, 25% villous component, high-grade intraepithelial neoplasia and non invasive carcinoma), the recurrence rate of the three groups were compared using chi square test, and compared with Kaplan-Meier survival analysis of high risk group and the low risk group had a cumulative risk of recurrence; through the clinical risk index, including age, gender, family history, smoking history, BMI, using t test and chi square test risk estimates are at high risk of polyps in patients with initial colonoscopy. Results: in univariate analysis, patients aged 70 old, polyp diameter 0.5 cm, number 2 and scattered in the whole colon is a risk factor for recurrence (P=0.00), pathological type, compared with non invasive carcinoma, non neoplastic polyp recurrence (P=0.00), and tubular adenoma, hairy tubular adenoma adenomas with low grade, velvet, adenoma With the high level and non invasive carcinoma, P value was 0.05, no statistical significance. In multivariate analysis, the number of polyps are independent risk factors of recurrence (OR=2.36,95%CI 1.06-5.25), age, polyp diameter and position in multivariate analysis, is not the risk factors of recurrence; experience 6~87 months follow-up in 614 patients, the average recurrence rate was 58.6%, in 6~24 months, 24~36 months, 36~48 months, 48~87 months the 4 time period, the overall cumulative recurrence of polyps was 50.3%, 61.7%, 70.1%, 75%; high risk group, the cumulative recurrence rate was respectively 65.7%, 80.7%, 60.1%, 83.8% the low risk group; the total relapse rate were 22.7%, 40%, 53.8%, two 65.4%. group differences in cumulative risk of recurrence in patients with (c2=17.17, P=0.00). No risk group and low risk group were followed up for 48 months and 36 months were found in advanced adenomas and low risk group in 41 follow up July found a case of malignant polyps associated with part, without the risk of colon cancer was not found during the follow-up period; high risk group found that 4.1% in 24 months (11/271) advanced adenomas (mainly with diameter larger than 1 cm tubular adenoma or villi, containing ingredients) found 2 cases of invasive carcinoma in the 57 months of follow-up and 87 months. The patient's age, gender (male), smoking (smoking history and smoking history now), BMI (more than 23kg/m2), family history (first-degree relatives of colon cancer, colonic polyp History) (P0.05), can estimate the risk in patients with high risk of polyps. The age is 60 years old, male, have family history of colon cancer, colonic polyps, with a history of smoking and overweight patients are more likely to find high-risk polyps in the initial colonoscopy. Conclusion: age 1. initial colonoscopy, and number of polyps, diameter, and scattered in the colon is the related factors of recurrence, which is the number of recurrence independent risk The risk factors of non neoplastic polyps and other pathological types are not easy to relapse.2. polyp recurrence rate increases with time and high risk groups of patients with polyps after resection of the cumulative recurrence rate is higher than the low risk group. For the follow-up should be no more than 2 years of high risk group of patients undergoing endoscopic polypectomy. The low risk group in 3 years or so, no risk can be extended to 4 years of follow-up is safe.3. age, sex, body mass index, smoking history, family history and initial colonoscopy found associated with high risk of polyps.

【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R656.9

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