| 远近端大肠肿瘤相关性研究 |
| 投稿时间：2010-11-10 修订日期：2011-04-20 点此下载全文 |
| 引用本文：余志金,罗程,许岸高,姜泊.远近端大肠肿瘤相关性研究[J].医学研究杂志,2011,40(7):47-50 |
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| 基金项目:广东省医学科研基金资助项目(A2008754) |
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| 中文摘要:目的通过分析远、近端大肠肿瘤的相关性，探讨远端大肠腺瘤对预测近端大肠进展性肿瘤的价值。方法从2005~2009年在惠州市中心人民医院和南方医科大学附属南方医院行结肠镜检查的连续性患者资料中，选择50~79岁诊断为远端大肠腺瘤的患者资料，用非条件Logistic回归分析研究远、近端大肠肿瘤的相关性。结果大肠腺瘤的体积、异型增生程度、组织学类型、数目和患者的性别、年龄等6个变量经单因素Logistic回归分析发现，腺瘤的体积、组织学类型、数目和患者的性别、年龄有统计学差异(P<0.05)，而异型增生程度无统计学差异(P>0.05)。经多因素回归分析发现，腺瘤的体积、组织学类型、数目仍有统计学差异(P<0.05)，异型增生程度和患者的性别、年龄无统计学差异(P>0.05)。72.0%(311/432)近端大肠肿瘤患者远端大肠未发现肿瘤，其中80.8%(210/260)近端大肠进展性肿瘤患者远端大肠未发现肿瘤。结论远端大肠腺瘤直径≥10mm、绒毛组织>20%和多发均增加同时存在近端进展性肿瘤的危险。如果乙状结肠镜发现远端大肠肿瘤才进行全结肠镜检查，将减少23.1%全结肠镜检查量，但可能漏诊72.0%近端大肠肿瘤，其中80.8%为近端大肠进展性肿瘤。提示大肠癌筛查应首选结肠镜而非乙状结肠镜。 |
| 中文关键词:结直肠肿瘤 发病部位 结肠镜 |
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| Abstract:ObjectiveTo investigate the predictive value of distal colorectal adenomas for proximal colorectal advanced tumor. MethodsThe study included subjects aged 50-79 years old who consecutively underwent full colonoscopy and were found to have distal colorectal adenomas from Huizhou Central People's Hospital and Guangzhou Nanfang Hospital during 2005-2009. Data of these patients were analyzed. Unconditional logistic regression was applied to analyze the correlation of distal and proximal colorectal neoplasms. Results72.0% (311/432) patients with proximal colorectal neoplasms had no distal colorectal neoplasms, and 80.8% (210/260) patients with proximal colorectal advanced neoplasms had no distal colorectal neoplasms. Univariate logistic regression analysis indicated that size, histological classification, sex, age of patients and frequency of distal colorectal adenomas were found significant difference (P<0.05), but dysplasia grade of distal colorectal adenomas was not (P>0.05). Multivariate logistic regression analysis indicated that size, histological classification and frequency of distal colorectal adenomas remained significantly different (P<0.05). ConclusionDistal colorectal adenomas ≥10mm in diameter or villous components >20% or multiple adenomas can increase the risk of proximal colorectal advanced neoplasia. Patients with neoplasms in distal colorectum were found by sigmoidoscopy, and subsequently accepted colonoscopy, of whom 231% would be reduced, but 72.0% patients with proximal colorectal neoplasms would be missed, which included 80.8% patients with proximal colorectal advanced neoplasms., The colonoscopy should be recommended as first-choice in colorectal cancer screening, but not sigmoidoscopy. |
| keywords:Colorectal neoplasm The subsite location Coloscopy |
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