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Pathologic features of initial adenomas as predictors for metachronous adenomas of the rectum
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- Author:
- No author available
- Journal Title:
- CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
- Issue:
- 2
- DOI:
- 10.3760/cma.j.issn.1671-0274.2000.02.005
- Key Word:
- 直肠腺瘤;异时性腺瘤;病理学
Abstract： 目的探讨直肠原发腺瘤的病理学特征与直肠异时性腺瘤再发的关系.方法自1977年至1978年用15 cm直肠镜对海宁县185 851居民进行直肠肿瘤筛查,共发现1 490例直肠腺瘤患者.这些患者在直肠腺瘤切除后,用内镜检查方法分别于第2、4、6、11及16年进行随访,观察直肠有无新生的异时性腺瘤.并分析首次筛查发现直肠腺瘤的病理学特征与发生直肠新生异时性腺瘤、重度不典型增生腺瘤和癌的关系及相对危险性.结果随访中发现280例患者在直肠内发生了新腺瘤.具有2个以上的原发腺瘤、原发腺瘤直径大于1 cm、绒毛状/混合型和中、重度不典型增生腺瘤患者发生异时性腺瘤的危险性升高2～3倍,具有统计学意义.大于1 cm腺瘤,绒毛状/混合型腺瘤及重度不典型增生腺瘤与发生癌或异时性重度不典型增生腺瘤明显相关,其相对危险性分别为4.2(1.8～9.9)、8.1(4.2～15.6)和14.4(5.0～41.3).与伴轻度不典型增生、小于或等于1 cm腺瘤的患者相比,伴重度不典型增生、超过1 cm腺瘤的患者发生异时性直肠肿瘤的相对危险性为37(7.8～174.7).结论直肠异时性腺瘤的危险性与原发腺瘤的病理学特征密切相关,因此,在高危组腺瘤患者的原发腺瘤切除后,应对他们进行密切监视.
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