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目的 探讨老年人大肠息肉的临床特点及其与癌变的关系。 方法 对我院经结肠镜检出的 158例老年大肠息肉患者的临床特点进行回顾性分析 ,对其中 12 0例进行 1～ 6年 (平均 4 5年 )的结肠镜随访 ,并与青中年组的 43 7例患者相对照。 结果 老年人大肠息肉的检出率、癌变率分别为 3 0 0 %及 2 3 4% ,均显著高于中青年组的 10 2 %及 6 9% (P <0 0 1) ,随年龄增长检出率有逐渐增加的趋势。分布以直肠和乙状结肠多见 ,但升结肠的癌变率 ( 3 7 5% )明显高于左半结肠( 14 3 % ,P <0 0 5) ,且直肠、降结肠、横结肠及升结肠的癌变率也显著高于青中年组的同一部位 (P <0 0 1) ;病理类型以腺瘤性息肉为多 ,占 77 6% ,也明显高于青中年组的同一病理类型 (P <0 0 1)。 3 7例癌变息肉均为腺瘤性息肉 ,其中绒毛状腺瘤的癌变率 ( 56 9% )显著高于管状腺瘤 ( 3 4% ,P <0 0 1)。息肉体积大 ( >2cm)、基底宽、数量多 ,癌变率高。腺瘤性息肉经内镜下摘除者其癌变率明显低于未摘除者 (P <0 0 1)。 结论 老年人大肠息肉中的腺瘤性息肉的大小、形态、数量及病理类型是其癌变的主要危险因素 ,老年人应尽量行全结肠检查 ,检出大肠息肉者应尽可能首选肠镜下摘除 ,定期随访 ,减少癌变的机会。
Objective To investigate the clinical features of colorectal polyps in the elderly and its relationship with carcinogenesis. Methods The clinical features of 158 cases of colorectal polyps detected by colonoscopy in our hospital were analyzed retrospectively. One hundred and six patients (average 45 years) underwent colonoscopy follow-up, Group 437 patients compared. Results The detection rates of colorectal polyps in the elderly were respectively 30% and 23%, which were significantly higher than those of the middle-aged and young patients (102% and 69%, P <0.01) The detection rate tends to increase gradually. The distribution was more common in the rectum and sigmoid colon, but the rate of ascending colon (37.5%) was significantly higher than that in the left colon (14.3%, P <0.05), and the canceration of the rectum, descending colon, transverse colon and ascending colon (P <0.01). The number of pathological types was 77.6% with adenomatous polyps, which was also significantly higher than that of the middle-aged group (P < 0 0 1). All 37 cases of cancerous polyps were adenomatous polyps, in which the rate of carcinogenesis of villous adenoma (56 9%) was significantly higher than that of tubular adenoma (34%, P 0 01). Polyp volume (> 2cm), wide base, the number of large, high rate of cancer. Adenocarcinoma polyp endoscopically removed their cancer rate was significantly lower than those without removal (P <0.01). Conclusion The size, shape, quantity and pathological type of adenomatous polyps in the colorectal polyps of the elderly are the main risk factors of carcinogenesis. The elderly should try their best to examine the whole colon, and colon polyps should be removed by colonoscopy as far as possible Regular follow-up to reduce the chance of cancer.