Gastroenterology:肠道息肉患者结肠镜复查间隔研究

2019-07-16 MedSci MedSci原创

根据本次研究建议在诊断晚期腺瘤和大锯齿状息肉后3年内进行内镜复查。相比之下,患有非晚期腺瘤或小锯齿状息肉的患者可以延长复查间隔

内镜检查可及时发现传统腺瘤或锯齿状息肉等前体病变,降低了直肠癌(CRC)的发病率和死亡率。目前前病变后复查监测间隔的指导方针尚不系统,特别是对于有锯齿状息肉的患者。

研究人员对122899名接受乙状结肠检查或结肠镜检查的患者进行了首次内镜检查的结果与CRC风险的相关性研究。内镜检查结果可分为无息肉、常规腺瘤或锯齿状息肉(增生性息肉、传统锯齿状腺瘤或无柄锯齿状腺瘤,伴或不伴细胞学不典型增生)。传统的腺瘤分为晚期(≥10 mm,高级别异型增生,或管状绒毛或绒毛组织学)或非晚期,锯齿状息肉分为大息肉(≥10 mm)或小息肉(<10 mm)。

经过10年的中位随访,共记录了491例CRC的病例:其中6161例常规腺瘤患者中51例,5918例锯齿状息肉患者中24例,112107例无息肉者中427例。与初次内镜检查未检出息肉者相比,晚期腺瘤患者发生CRC的多变量HR为4.07,有大锯齿状息肉患者发生CRC的HR为3.35。相反,非晚期腺瘤患者(HR,1.21)或小锯齿息肉患者(HR=1.25)的CRC风险无明显增加。

根据本次研究建议在诊断晚期腺瘤和大锯齿状息肉后3年内进行内镜复查。相比之下,患有非晚期腺瘤或小锯齿状息肉的患者可以延长复查间隔。

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    2019-07-25 许安
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    2019-07-18 zhouqu_8
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