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先天性肝内胆管扩张症癌变4例报告

眼睑结膜乳头状瘤样增生伴灶性癌变一例

Peutz-Jeghers综合征肠道息肉恶变的临床分析

目的探讨Peutz-Jeghers综合征肠道息肉恶变的临床诊治经验。 方法对2005～2015年期间所诊治的221例Peutz-Jeghers综合征患者中11例息肉恶变患者的临床病理资料进行回顾性分析。 结果11例PeutzJeghers综合征息肉恶变患者确诊时的中位年龄为31.36岁。行肠镜20例次，胃镜8例次，双气囊电子小肠镜19例次，胶囊内镜1例次。手术原因依次为肠梗阻、肠套叠、息肉恶变和消化道出血。癌变息肉分别位于十二指肠（4例）、小肠（4例）和结直肠（3例）。病理类型以管状腺癌（5例）和黏液腺癌（5例）最多见。本组11例患者均无手术死亡，1例术后发生腹部切口感染，经伤口换药等处置后出院。术后3例患者接受XELOX方案化疗，其余未作特殊治疗。1例术后失访，10例随访1个月至7年（中位随访期2.12年），其中4例术后1～3个月死于十二指肠癌肝肺转移、空肠腺癌肝转移和结肠癌肝肺多发转移，其余患者定期复查消化内镜或消化道造影等检查至今。 结论PeutzJeghers综合征息肉恶变患者年龄较小，早诊断、早治疗、定期复查可提高患者的检出率和临床治疗效果。

The clinical and pathological characteristics of advanced colorectal adenomatous polyps

ObjectiveTo investigate the clinical and pathological characteristics of advanced colorectal adenomatous polyps. MethodsPatients with colorectal adenomatous polyps diagnosed after colonoscopy in the Division of Gastroenterology of Zigong First People’s Hospital from January 2013 to March 2019 were selected. The patients were divided into advanced colorectal adenomatous polyps group (advanced group) and non advanced colorectal adenomatous polyps group (non advanced group), to analyze the location distribution, pathological type and the relationship with carcinogenesis of advanced colorectal adenomatous polyps. Results A total of 1 555 patients were included. There were 223 cases (14.34%) in the advanced group and 1 332 cases (85.66%) in the non advanced group. There was no significant difference in the distribution of canceration in postoperative pathological examination (P=1.000), but there was significant difference in other indexes between the two groups (P<0.05). The detection rate of high-grade intraepithelial neoplasia in the advanced group was higher in tubular adenoma than that in villous-tubular adenoma (41.18% vs. 13.74%; χ2=18.959, P<0.001). There was no significant difference in the detection rate of high-grade intraepithelial neoplasia between tubular adenoma and villous adenoma (41.18% vs. 25.00%; χ2=1.992, P=0.220). In the advanced group, 40 cases (17.94%) were at the right colon and 183 cases (82.06%) at the left colon. In the detection rate of high-grade intraepithelial neoplasia in the left colon, there was no significant difference between villous adenoma and villous-tubular adenoma (17.65% vs. 14.41%; χ2=2.801, P=0.094) or tubular adenoma (17.65% vs. 41.82%; χ2=3.289, P=0.088); the rate in tubular adenoma was higher than that in villous-tubular adenoma (41.82% vs. 14.41%; χ2=9.322, P=0.002). There was no significant difference in the detection rate of canceration among tubular adenoma, villous-tubular adenoma and villous adenoma in the advanced group (χ2=3.002, P=0.249). Conclusions At present, colorectal adenomatous polyps should be paid attention to. Endoscopic physicians should master the clinical and pathological characteristics of advanced colorectal adenomatous polyps, in order to raise the detection efficiency of advanced adenoma polyps and cancerous cases.