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目的：提出易导致腺瘤复发或癌变的高危特征和因素，延长非高危人群的结肠镜随访间期，从而降低医疗费用。方法：行结肠镜下腺瘤摘除术患者５０４例，随访间期６～４８个月，分析年龄、性别、腺瘤数量、最大直径和病理类型等因素与腺瘤复发的关系。结肠镜复查时发现以下病变者归人高危人群：绒毛管状腺瘤、绒毛状腺瘤、重度不典型增生／原位癌、浸润性癌或腺瘤直径≥ １ｃｍ及复发腺瘤数≥ ４枚。结果：经相关分析，腺瘤复发与原腺瘤数量和大小的增加呈正相关（Ｐ＜０．００１），与年龄、性别、原腺瘤病理类型及结肠镜随访间期等因素无关。结论：可延长低危人群（首次结肠镜检查仅发现１或２枚腺瘤且直径均＜１ｃｍ者）的结肠镜随访间期，从而大大降低结肠癌监控的费用。
OBJECTIVE: To present high-risk features and factors that may lead to recurrence or canceration of adenomas, prolong the period of follow-up of colonoscopy in non-high-risk groups, and thereby reduce medical costs. METHODS: A total of 504 patients underwent colonoscopic adenoma surgery were followed for 6 to 48 months. The relationship between age, sex, number of adenomas, maximal diameter, pathological type, and recurrence of adenoma was analyzed. During colonoscopy, the following lesions were found in high-risk populations: villous tubular adenoma, villous adenoma, severe dysplasia/in situ carcinoma, invasive carcinoma or adenoma diameter ≥ 1cm, and recurrent adenoma number ≥ 4. RESULTS: After correlation analysis, the recurrence of adenomas was positively correlated with the increase in the number and size of primary adenomas (P<0.001), and was not related to factors such as age, gender, pathological type of primary adenoma, and follow-up period of colonoscopy. Conclusions: The colonoscopic follow-up interval can be prolonged in low-risk populations (only one or two adenomas are found on the first colonoscopy and the diameter is less than 1cm), thus greatly reducing the cost of colon cancer surveillance.