【作者】 王志永；

【导师】 徐红；

【作者基本信息】 吉林大学 ， 内科学， 2010， 硕士

【摘要】 在西方国家,大肠癌是最常见的肿瘤且其是引起癌症相关死亡的主要的原因。在中国,大肠癌的发生率也在逐年增加。大肠息肉,尤其是腺瘤性息肉,被认为是大肠癌的癌前病变。有学者根据与大肠癌相关与否将大肠息肉分为肿瘤性息肉和非肿瘤性息肉。大肠肿瘤性息肉是指腺瘤性息肉、不典型增生及早期癌。所以发现并切除大肠肿瘤性息肉可以降低大肠癌的发生率和死亡率。目前,临床上对于大肠息肉的处理大部分学者认为应该先进行活组织检查后再决定进一步的治疗方案,因为非肿瘤性息肉并不需要内镜下切除,这个诊疗过程既费时费力且增加了诊疗的费用。因此,在体内准确的鉴别肿瘤性息肉与非肿瘤性息肉尤为重要。因为这样可以即时的决定是否需要进行息肉切除术,这会使得结肠镜检查更为有效。自从大肠“高危”肿瘤的概念提出之后,更多的学者关注大于10mm的大肠息肉。有研究显示在结肠镜检查中有90%是大肠小息肉(<10mm),在组织学类型上,最初的数据显示80-90%的大肠小息肉(<10mm)是增生性息肉,但是最近的研究显示40%-50%的大肠小息肉是肿瘤性息肉。所以明确大肠小息肉的发生率及其病理特点显得尤为重要。体内即时的诊断大肠小息肉的病理类型(肿瘤性还是非肿瘤性息肉)也会使得结肠镜诊疗更加有效。本实验将大肠小息肉分为<5mm和6-10mm息肉组,旨在对大肠小息肉的内镜、病理特点及肿瘤性小息肉中的“高危”肿瘤进行对比分析以明确大肠小息肉的临床意义并评估高清电视图像结合窄带成像在大肠小息肉组织学诊断上的可行性。更多还原

【Abstract】 Background: Colorectal cancer (CRC) is one of the most common cancers diagnosed in Western countries and is major cause of cancer-associated morbidity and mortality. In China, the incidence of CRC is increaing rapidly. Colorectal polyps,especialy adenomatous polyps, is precancerous lesions of CRC. So the detection and subsequent removal of neoplastic colorecal lesions, including adenomatous polyps and aerly cancers can reduce CRC morbidity and mortality. Since the concept of“advanced”lesions was proposed, more scholars concerned polyps larger than 10 mm. Although initial data suggest that 80%-90% of small colorectal polyps(<10mm) are histologically heperplastic, more recent date indicate that 40%-60% of such polyps are neoplastic. The ability to accurately differentiate the neoplastic and non-neoplastic polyps is useful because it obviates the need for biopsiea during colonoscopy and for removal of small polyps. Accurate optical diagnosis of small (<10 mm) colorectal polyps in vivo, without formal histopathology could make colonoscopy more efficient and cost effective. The aim of this study was to assess whether optical diagnosis of small polyps with HDE with NBI is feasible and safe in routine clinical practice. Methods Consecutive patients with a positive small coloractal polyps(<10mm) in routine colonoscopy at The First Hospital of Jilin University(Changchun, China), from January 1, 2008, to October 1, 2009, were included in this prospective study.Patient with inflammatory bowel disease (IBD), Hereditary non-polyposis colorecal cancer (HNPCC), familial adenomatous polyposis (FAP) and polyps larger than 10 mm were excluded from this study.Experimented colonoscopist predicted polyp histology using optical diagnosis with High Definition Endoscopy (HDE), followed by narrow-band imaging without chromoendoscopy, as required. The primary outcome was accuracy of polyp characterisation using optical diagnosis compared with histopathology, the current gold standard. Findings 501 polyps smaller than 10 mm were detected. By histology, 358 of these polyps were neoplastic lesions(71.5%) and 143 were non-neoplastic lesions (of which 122 were hyperplastic). In group of 6-10mm polyps, 61 of 64 polyps were neoplastic lesions (95.3%). In group of polyps small than 5mm,297 of 437 polyps were neoplastic lesions(67.9%). Optical diagnosis accurately diagnosed 325 of 358 neoplasic lesions (sensitivity 0·91) and 111 of 143 hyperplastic polyps (specificity 0·77), with an overall accuracy of 435 of 501(0·87) for polyp characterisation. Outcomes: In our study, for polyps less than 10 mm in size, the neoplastic polyps has larger proportion (>65%), especially 6-10mm polyps (95.3%). So we suggeated polypectomy was conduced once a 6-10mm polyps was found. For polyps less than 10 mm in size, in-vivo optical diagnosis seems to be an acceptable strategy to assess polyp histopathology. Dispensing with formal histopathology for most small polyps found at colonoscopy could improve the efficiency of the procedure and lead to substantial savings in time and cost.更多还原