结肠息肉切除术后复发相关因素研究进展

结肠息肉切除术后复发相关因素研究进展〔〕:

摘要：结肠息肉是消化系统常见疾病被视为结肠癌癌前病变，内镜下息肉切除作为常规治疗术后存在较高复发率。研究说明结肠息肉复发与息肉病理类型、大小、数目、内镜手术方式等因素相关。进步对结肠息肉切除术后复发因素的认识，对于制定术后个体化随访指南、降低结肠癌发病率具有重要意义。本文结合近几年最新研究进展将结肠息肉复发相关因素总结作一综述。

关键词：结肠息肉；复发因素；研究进展

本文引用格式：陈月,汪元浚.结肠息肉切除术后复发相关因素研究进展[J].世界最新医学信息文摘,2022,19(66):125-126,128.

AdvancesintheStudyofRelapsingFactorsafterColonicPolypectomy

CHENYue,WANGYuan-jun*

(GraduateSchoolofQingHaiUniversity,XiningQinghai)

ABSTRACT:Colonpolypsisoneofamondiseasesinthedigestivesystem,whichisconsideredasprecancerouslesionsofcoloncancer.Endoscopicpolypectomyasaroutinetreatmentstillhasahighrecurrencerate.Relatedresearchersshowthattherecurrenceofcolonpolypswererelatedtothepathologicaltypes,size,numbersandthetypesofendoscopicsurgeryforpolyps.Ithasagreatsignificancetoimprovetheawarenessofthefactorsaboutthepolyprecurrencewhichisvaluableforthedevelopmentofpostoperativeindividualizedfollow-upguidelinesandthereductionoftheincidenceofcoloncancer.Inthisreview,thefactorsrelatedtotherecurrenceofcolonicpolypswerereviewed.

KEYWORDS:Colonicpolyp;Recurrencefactors;Researchprogress

0引言

结肠息肉作为消化道常见病、多发病因其具有癌变可能而被广泛关注，目前内镜下结肠息肉切除的普遍开展成为预防结肠癌并降低其死亡率的有利工具[1-3]。然而结肠息肉切除术后仍存在息肉复发和癌变可能，有研究说明结肠息肉术后3-5年内复发率约占3.9%-48.3%[3-5]。目前内镜下息肉切除术后建议定期复查肠镜[6-7]。提醒内镜下结肠息肉复发的相关因素有助于制定个体化的随访时间及监测方案，本文归纳总结国内外关于有关结肠息肉复发相关因素归纳如下。

1镜检病理类型

根据结肠息肉病理组织学检查结果可分为：炎性息肉、增生性息肉、管状腺瘤、绒毛状腺瘤、锯齿状息肉等，研究认为，管状腺瘤、绒毛状腺瘤、锯齿状息肉、重度上皮内瘤变等具有高级别组织学类型的息肉复发的独立危险因素[8,9]。绒毛组织>10mm或合并高度发育不良的病理组织学类型的息肉称为晚期腺瘤，晚期腺瘤与非晚期腺瘤相比复发风险更高〔P

2大小

息肉大小为息肉复发的危险因素[8，12-13]。有研究认为，腺瘤性息肉大于40mm为复发的独立危险因素[12,13]。目前认为，息肉大小是影响息肉切除残存组织最重要因素之一，直径>20mm的腺瘤性息肉中约有4.3%-36.7%存在残留组织[9，12，14]，息肉不完全切除与复发风险独立相关〔P=0.002〕【5】。

3数目

息肉数目影响结肠息肉的复发[4，6，15-16]。HuiWon等[15]研究认为息肉数目≧3个为复发的独立危险因素〔P=0.047〕；JasperL.A等[16]认为5个以上非晚期小腺瘤晚期瘤变风险大于3个或4个小腺瘤者。

4部位

有学者认为[17]近端结肠〔包含升结肠、结肠肝曲、横结肠、结肠脾曲〕的息肉为复发独立危险因素〔P

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