结直肠锯齿状息肉的临床、内镜及病理特征分析

Analysis of clinical, endoscopic and pathological features of colorectal serrated polyp

摘要:

目的 探究结直肠锯齿状息肉（SP）的临床、内镜及病理特征。方法 回顾性分析2013 年9 月 -2016 年5 月山东大学第二医院内镜中心检出的232 例结直肠SP 患者的临床内镜及病理资料，采用χ2 检验 对SP 不同病理分型的内镜特征进行比较。结果 232 例SP 患者，男153 例，女79 例；年龄18 ～ 86 岁，平均 （52.38±12.67）岁。共检出251 枚SPs，增生性息肉（HP）165 枚（65.7%）、无蒂锯齿状腺瘤/ 息肉（SSA/P） 85 枚（33.9%）和传统锯齿状腺瘤（TSA）1 枚（0.4%）。HP 和SSA/P 在息肉分布部位、大小及形态方面的 差异有统计学意义（χ2=14.68、37.98 和74.83，均P =0.000）。85 枚SSA/P 中，伴和未伴细胞异型增生型分 别为66 枚（77.6%）和19 枚（22.4%）。两者息肉形态的比较，差异有统计学意义（χ2=5.98，P =0.015），而 息肉分布部位及大小比较差异均无统计学意义（χ2=0.07 和1.56，P =0.932 和0.211）。结论 HP 和SSA/P 有 其自身的内镜特点，结合息肉部位、大小及形态有助于区分。而SSA/P 不同病理分型的内镜特点，仍需要扩 大样本量进一步研究。

Abstract:

Objective To investigate clinical, endoscopic and pathological features of colorectal serrated polyp (SP). Methods Clinical, endoscopic and pathological data of 232 patients with at least one colorectal serrated polyp detected at Endoscopic Center of the Second Hospital of Shandong University from September 2013 to May 2016 were retrospectively analyzed. Endoscopic features of different pathological types of SP were compared by χ2 test. Results In the 232 patients with at least one colorectal serrated polyp, there were 153 males and 79 females, with the age ranging from 18 to 86 y and the mean age of (52.38 ± 12.67) y. There were totally 251 SPs, including 165 hyperplastic polyps (HP, 65.7%), 85 sessile serrated adenomas or polyps (SSA/P, 33.9%), and 1 traditional serrated adenoma (TSA, 0.4%). Significant differences were observed between HP and SSA/P in the location, size and morphology (χ2 = 14.68, 37.98 and 74.83, P = 0.000). The proportions of 66 SSA/P with dysplasia and 19 SSA/ P without dysplasia in the 85 SSA/P were 77.6% and 22.4%, respectively. A significant difference was observed between the two groups in the morphology (χ2 = 5.98, P = 0.015), whereas no significant difference was observed in the location or size (χ2 = 0.07 and 1.56, P = 0.932 and 0.211). Conclusions HP and SSA/P have their own endoscopic features, and combination with location, size and morphology of polyps helps to distinguish them. However, with respect to endoscopic features of different pathological types of SSA/P, we still need to enlarge the sample size for further study.