结肠憩室合并结肠肿瘤临床特征分析

Clinical characteristics of colonic diverticulosis combined with colorectal neoplastic lesions

关键词:  结肠憩室  结肠腺瘤  进展期腺瘤

Key words:  colonic diverticulosis  colorectal adenoma  advanced neoplasia

摘要:

目的 分析结肠憩室合并结肠肿瘤的临床特征及风险与转归。方法 回顾分析2012年1月—2019年7月于同济大学附属同济医院行结肠镜检查的63 417例患者的临床资料。按有无结肠憩室将患者分为憩室组（n=1 616）和无憩室组（n=45 243），采用多因素Logistic回归分析结肠憩室与结肠肿瘤之间的关系，探讨结直肠息肉合并憩室的风险与转归。结果 憩室组患者结肠息肉、腺瘤和进展期腺瘤的比例明显高于无憩室组（P<0.05）。两组患者的锯齿状病变和结肠癌的比例差异无统计学意义（P>0.05）。多因素Logistic回归分析显示: 结肠憩室是息肉和腺瘤检出的独立危险因素（OR>1，P<0.05），而与锯齿状病变和结肠癌之间无显著关系。近端、远端或双侧结肠憩室患者均有较高的息肉和腺瘤检出率（P<0.05）。息肉和腺瘤的检出率随着憩室数量的增加而增加（P<0.05）。近端和远端憩室合并结肠息肉出现不典型增生的风险较低。结论 结肠憩室与结肠息肉和腺瘤的检出显著相关，但并不增加同一结肠段息肉的风险。

Abstract:

Objective To analyze the clinical characteristics of colonic diverticulum(CD) combined with colorectal neoplastic lesions. Methods Clinical data of 63 417 patients who underwent colonoscopy at Tongji Hospital between January 2012 and July 2019 were retrospectively analyzed. CD was detected in 1 616 cases(CD group) and 45 243 cases without CD served as control group. The association between CD and colorectal neoplasia was analyzed and the factors related to colorectal neoplastic lesions in CD patients was examined with multivariate logistic regression. Results The proportion of polyps, adenoma and advanced neoplasia was significantly higher in CD group than that in control group(P<0.05), but there were no significant differences in proportion of serrated lesions and colorectal cancer between two groups(P>0.05). Multivariate logistic regression analysis showed that CD was an independent risk factor for polyp and adenoma(OR>1, P<0.05), but there was no significant relationship between CD and serrated lesions or advanced neoplasia. Proximal, distal, and bilateral CD were all significantly associated with a higher detection rate of polyp and adenoma in CD patients. Furthermore, the detection rates of polyp and adenoma were increased with the increased number of diverticula. The risk of dysplasia was decreased in patients who had proximal or distal diverticulosis and polyps located in the same colonic segment. Conclusion CD is significantly associated with the development of polyp and adenoma, but it seems not to increase the risk of dysplasia in polyps located in the same colonic segment.