目的 探讨临床应用电子结肠镜活组织检查标本的病理诊断疾病谱特征,提出早期发现恶性肿瘤及癌前病变的综合策略。方法 提取武警特色医学中心2014-07至2024-08经电子结肠镜采样的13 971例病理诊断结果,分析其疾病谱特点,以及癌前病变和良恶性肿瘤的发病部位、病理类型、性别、年龄等临床病理学特征。结果 13 971例中,常见病变依次为结直肠良性肿瘤、炎症性疾病、恶性肿瘤及其他疾病,其中良性肿瘤常见病种依次为传统型腺瘤、锯齿状病变和息肉、脂肪瘤及平滑肌瘤;炎症性疾病常见病种依次为慢性炎症、炎症性肠病,慢性炎症与炎症性肠病在部位构成上差异显著(P<0.0001),后者多部位受累比例更高;恶性肿瘤常见病种依次为腺癌、神经内分泌肿瘤、淋巴瘤及恶性黑色素瘤,其中腺癌和神经内分泌肿瘤易于左半结肠检出。癌前病变中,管状腺瘤、绒毛状-管状腺瘤、绒毛状腺瘤易于左半结肠检出。对比中青年患者,管状腺瘤与传统锯齿状腺瘤在老年患者中多部位检出比例显著增大,差异有统计学意义(P<0.01)。传统锯齿状腺瘤易于左半结肠检出,且以男性居多。结论 电子结肠镜活组织检查患者中,良性肿瘤最为常见,且以癌前病变管状腺瘤居多,而恶性肿瘤以腺癌居多且易于左半结肠检出。不同疾病在年龄、性别与部位分布上具有特征性差异,可为临床早期识别与风险分层提供参考。
Abstract
Objective To explore the characteristics of the disease spectrum in the pathological diagnoses of biopsy specimens obtained through electronic colonoscopy in clinical application, and to propose a comprehensive strategy for early detection of malignant tumors and precancerous lesions. Methods The pathological diagnosis results of 13,971 electronic colonoscopy examinations conducted at Characteristics Medical Center of Chinese People’s Armed Police Force from July 2014 to August 2024 were extracted. The characteristics of disease spectrum were analyzed, as well as the clinical pathological features such as the location, pathological type, gender and age of precancerous lesions and benign tumors. Results Among the 13,971 cases, the common lesions were benign tumors, inflammatory diseases, malignant tumors and other diseases. The common types of benign tumors were traditional adenomas, serrated lesions and polyps, lipomas, and leiomyomas. The common types of inflammatory diseases were chronic inflammation and inflammatory bowel disease, with significant difference in the composition of affected sites (P<0.0001), and the latter had a higher proportion of multi-site involvement. The common types of malignant tumors were adenocarcinoma, neuroendocrine tumors, lymphoma, and malignant melanoma, among which adenocarcinoma and neuroendocrine tumors were likely to be detected in the left half of the colon. In precancerous lesions, tubular adenomas, tubulovillous adenoma, and villous adenoma were more likely to be detected in the left half of the colon. Compared with young and middle-aged patients, the proportion of multi-site detection of tubular adenomas and traditional serrated adenomas significantly increased in elderly patients, and the difference was statistically significant (P<0.01). Traditional serrated adenomas were more likely to be detected in the left half of the colon in males. Conclusions In the spectrum of pathologically diagnosed diseases based on electronic colonoscopy biopsy, benign tumors are the most common, and precancerous lesions are mostly tubular adenomas, while adenocarcinomas are the most common malignant tumors and are more likely to be detected in the left half of the colon. Different diseases exhibit characteristic differences in age, gender, and location distribution, which can provide reference for early clinical identification and risk stratification.
关键词
电子结肠镜 /
恶性肿瘤 /
癌前病变 /
疾病谱 /
筛查
Key words
electronic colonoscopy /
malignant tumor /
precancerous lesion /
disease spectrum /
screening
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基金
天津市卫生健康科技项目(TJWJ2025MS057)
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