本文關(guān)鍵詞： 大腸息肉 結(jié)腸鏡 病理學(xué)　出處：《大連醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：分析大腸息肉患者的發(fā)病情況、臨床癥狀、內(nèi)鏡表現(xiàn)、病理類型及癌變特點(diǎn),以期提高認(rèn)識、早期發(fā)現(xiàn)、及時治療。方法：選取2012年1月至2014年6月于我院行結(jié)腸鏡檢查的3798例住院患者,共檢出的大腸息肉患者1347例,發(fā)現(xiàn)息肉總計4005枚,其中1247例患者通過內(nèi)鏡下活檢或完整摘除明確病理性質(zhì)。檢查過程中詳細(xì)記錄大腸息肉患者的性別、年齡、臨床表現(xiàn)、內(nèi)鏡特點(diǎn)、病理類型及癌變情況,制定分類及評價標(biāo)準(zhǔn)并建立數(shù)據(jù)庫,根據(jù)資料特點(diǎn)采用PearsonΧ2檢驗、Fisher確切概率法、二元非條件Logistic回歸分析及Kruskal-Wallis秩和檢驗進(jìn)行統(tǒng)計學(xué)分析,差異有統(tǒng)計學(xué)意義時進(jìn)行組間多重比較。結(jié)果：大腸息肉患者的檢出率為35.47%,其中青、中、老年組檢出率分別為15.07%、33.4%、46.14%,男性明顯高于女性(41.61%29.28%),差異有統(tǒng)計學(xué)意義(P0.01),回歸分析顯示年齡和性別為大腸息肉發(fā)生的獨(dú)立危險因素,其中年齡危險因素較高。臨床癥狀主要表現(xiàn)為腹痛37.79%、腹瀉12.69%、便秘8.69%、便血8.54%、腹脹7.72%、消瘦4.31%、腹瀉與便秘交替2.75%,無消化道癥狀者占17.52%,其中中、老年組便血癥狀及無癥狀者較青年組明顯增多,而腹瀉發(fā)生率降低,青年組腹痛高于老年組,組間差異具有顯著性(P0.017)。息肉分布主要位于遠(yuǎn)端大腸,其中直腸占32.03%、乙狀結(jié)腸27.49%、橫結(jié)腸15.13%,不同年齡或病理類型組息肉分布特點(diǎn)未見明顯差異(P0.05)。大腸息肉發(fā)生數(shù)量以多發(fā)為主(63.25%),但青年組中單發(fā)較常見(50.96%)；大小以直徑≤0.5cm為主(81.35%),形態(tài)特點(diǎn)主要表現(xiàn)為無蒂(Ⅰ、Ⅱ型,58.60%)、表面光滑(86.82%),以上特征在不同年齡組中比較差異顯著(P0.05)。病理類型構(gòu)成主要為管狀腺瘤40.13%、增生性息肉33.22%、炎性息肉18.03%,與青、中年組以非腺瘤性息肉為主不同,老年組中腺瘤較多(56.08%,P0.017)：男性與女性各病理類型比例相似(P0.05)；腺瘤常見于多發(fā)(54.41%)、直徑較大0.5cm(73.35%)、[II、Ⅳ型(亞蒂、有蒂型,62.87%)、分葉(88.43%)的息肉中,差異有顯著性意義(P0.01)。所有類型息肉均可發(fā)生異型增生,以輕、中度異型為主,其中腺瘤占主要部分(88.11%),重度異型增生及癌變均見于腺瘤,癌變率為2.67%,以絨毛狀腺瘤和絨毛管狀腺瘤癌變率最高,常見于多發(fā)(1.7%)、表面分葉(10.32%)、直徑2.0cm(11.58%)的息肉中,差異有顯著性(P0.05)；不同年齡、性別、部位及分型組的癌變率比較未見明顯不同(P0.05)。結(jié)論：1.年齡和性別是大腸息肉發(fā)生的危險因素。2.大腸息肉的大小以直徑≤0.5cm多見,形態(tài)以光滑、無蒂為主,分布常見于直腸和乙狀結(jié)腸,其分布特點(diǎn)與年齡和病理類型無關(guān)。3.腺瘤具有易多發(fā)、體積大、形態(tài)不規(guī)則的特點(diǎn),好發(fā)于老年；多發(fā)、直徑2.0cm、表面分葉或伴重度異型增生的絨毛管狀腺瘤和絨毛狀腺瘤發(fā)生癌變可能性大。4.有消化道癥狀者和中老年人群需早期行結(jié)腸鏡檢查,對發(fā)現(xiàn)的息肉均應(yīng)完整切除,并根據(jù)病理指導(dǎo)下一步隨訪。
[Abstract]:Objective: to analyze the incidence, clinical symptoms, endoscopic manifestations, pathological types and canceration characteristics of patients with colorectal polyps in order to improve their understanding and early detection. Methods: from January 2012 to June 2014, we selected 3 798 inpatients who underwent colonoscopy in our hospital. A total of 1 347 cases of colorectal polyps were detected, and a total of 4 005 polyps were found. Among them, 1247 patients were confirmed by endoscopic biopsy or complete excision. The sex, age, clinical manifestations, endoscopic features, pathological types and canceration of colorectal polyps were recorded in detail during the examination. The classification and evaluation criteria were established and the database was established. According to the characteristics of the data, the Pearson X 2 test and Fisher exact probability method, binary non conditional Logistic regression analysis and Kruskal-Wallis rank sum test were used for statistical analysis. Results: the detection rate of colonic polyps was 35.47. The positive rate in the elderly group was 15.07 and 33.4 respectively. The incidence rate of male was significantly higher than that of female. The difference was statistically significant (P 0.01). The regression analysis showed that age and sex were independent risk factors for colorectal polyps. The main clinical symptoms were abdominal pain 37.79, diarrhea 12.69, constipation 8.69, constipation 8.69, constipation 8.54, abdominal distension 7.72, weight loss 4.31, diarrhea and constipation alternating 2.75. The hematochezia symptoms and asymptomatic symptoms in the elderly group were significantly higher than those in the young group, but the incidence of diarrhea was lower. The abdominal pain in the young group was higher than that in the elderly group, and there was a significant difference between the two groups (P 0.017). The distribution of polyps was mainly located in the distal large intestine. There was no significant difference in the distribution of polyps in different age or pathological type groups (P 0.05). The number of polyps in large intestine was mainly multiple and 63.2525, but in the young group, the single occurrence was more common than that in the young group, and the diameter 鈮，

本文編號：1551506