不同病理类型结直肠息肉癌变的临床研究进展

doi:10.12114/j.issn.1007-9572.2022.0722

摘要/Abstract

摘要： 结直肠癌（CRC）是世界范围内常见的肿瘤之一，结直肠息肉是指高出肠黏膜的局部隆起性病变，约90%的CRC由息肉演变而来。传统观念认为，CRC的发生、发展大多是通过"腺瘤-癌"序列，但研究发现，锯齿状息肉中也形成了形态和基因不同的亚类，并与微卫星不稳定性CRC有密切联系，15%~30%的CRC是通过"锯齿状息肉-癌"途径发展。本文主要综述了结直肠腺瘤、锯齿状息肉以及炎症后息肉的临床特点，通过大样本的回顾性分析研究，总结不同病理类型结直肠息肉在癌变进展中的发生率以及结直肠息肉切除术后的随访监测时间表，更好地为结直肠息肉患者随访监测和癌前病变的早筛、早治提供参考。

关键词: 结肠息肉, 结直肠息肉, 结直肠肿瘤, 病理类型, 癌前病变, 综述

Abstract:

Colorectal cancer (CRC) is one of the most common tumors in the world. Colorectal polyps are local protuberant lesions that elevate the intestinal mucosa, and about 90% of CRC is evolved from polyp. According to the traditional concept, the occurrence and development of CRC is mostly through the "adenoma-cancer" sequence. However, studies have found that serrated polyps also form subclasses with different morphology and genes, and are closely related to microsatellite unstable CRC. About 15%-30% of CRC develops through the "serrated polyp-cancer" pathway. This article mainly reviewed the clinical characteristics of colorectal adenoma, serrated polyp and post-inflammatory polyps, through retrospective analysis of large samples, to summarize the incidence of different pathological types of colorectal polyps in the progression of carcinogenesis and the follow-up monitoring after polypectomy, so as to provide a better reference for follow-up monitoring of polyp patients and early screening and treatment of precancerous lesions.

Key words: Colonic polyps, Colorectal polyps, Colorectal neoplasms, Pathological types, Precancerous lesions, Review

禹蓉,董卫国,田山,等. 不同病理类型结直肠息肉癌变的临床研究进展[J]. 中国全科医学, 2023, 26(14): 1790-1794. DOI: 10.12114/j.issn.1007-9572.2022.0722.
YU Rong,DONG Weiguo,TIAN Shan, et al. Clinical Research Progress on Carcinogenesis of Different Pathological Types of Colorectal Polyps[J]. Chinese General Practice, 2023, 26(14): 1790-1794. DOI: 10.12114/j.issn.1007-9572.2022.0722.

图/表 1

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病理类型	息肉直径（mm）	息肉数量（个）	随访时间（年）
管状腺瘤	<10	1~2	1~3
	—	3~10	1~2
	—	>10	1
绒毛状腺瘤	≥10	—	1~2
增生性息肉	<10	—	2~3
无蒂锯齿状息肉	<10	—	2~3
	≥10	—	1~2
	>20	—	1
传统锯齿状息肉	≥10	—	1~2
腺瘤或锯齿状病变	—	≥5	1

病理类型	息肉直径（mm）	息肉数量（个）	随访时间（年）
管状腺瘤	<10	1~2	1~3
	—	3~10	1~2
	—	>10	1
绒毛状腺瘤	≥10	—	1~2
增生性息肉	<10	—	2~3
无蒂锯齿状息肉	<10	—	2~3
	≥10	—	1~2
	>20	—	1
传统锯齿状息肉	≥10	—	1~2
腺瘤或锯齿状病变	—	≥5	1