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目的 探讨直肠原发腺瘤的病理学特征与直肠异时性腺瘤再发的关系。方法 自 1977年至 1978年用 15cm直肠镜对海宁县 185 85 1居民进行直肠肿瘤筛查 ,共发现 1490例直肠腺瘤患者。这些患者在直肠腺瘤切除后 ,用内镜检查方法分别于第 2、4、6、11及 16年进行随访 ,观察直肠有无新生的异时性腺瘤。并分析首次筛查发现直肠腺瘤的病理学特征与发生直肠新生异时性腺瘤、重度不典型增生腺瘤和癌的关系及相对危险性。结果 随访中发现 2 80例患者在直肠内发生了新腺瘤。具有 2个以上的原发腺瘤、原发腺瘤直径大于 1cm、绒毛状 /混合型和中、重度不典型增生腺瘤患者发生异时性腺瘤的危险性升高 2～ 3倍 ,具有统计学意义。大于 1cm腺瘤 ,绒毛状 /混合型腺瘤及重度不典型增生腺瘤与发生癌或异时性重度不典型增生腺瘤明显相关 ,其相对危险性分别为 4 2 (1 8～ 9 9)、8 1(4 2～ 15 6 )和 14 4(5 0～ 41 3)。与伴轻度不典型增生、小于或等于 1cm腺瘤的患者相比 ,伴重度不典型增生、超过 1cm腺瘤的患者发生异时性直肠肿瘤的相对危险性为 37(7 8～174 7)。结论 直肠异时性腺瘤的危险性与原发腺瘤的病理学特征密切相关 ,因此 ,在高危组腺瘤患者的原发腺瘤切除后 ,应对他们进行密切监视。
Objective To investigate the relationship between pathological features of primary rectal adenomas and recurrence of heterotopic rectal adenomas. Methods From 1977 to 1978, rectal cancer screening was performed in 185 85 1 residents in Haining County with a 15 cm rectaloscope. A total of 1490 patients with rectal adenomas were found. After resection of rectal adenomas, these patients were followed up by endoscopy in 2, 4, 6, 11 and 16 years respectively to observe whether there was a newborn anaplastic adenoma in the rectum. The relationship between the pathological features of rectal adenomas and the occurrence of rectal neoplasms, severe dysplasia and carcinomas and the relative risk were also analyzed. Results During the follow-up, 280 neoplasms were found in the rectum. With more than two primary adenomas, primary adenoma diameter greater than 1cm, villous / mixed and moderate and severe dysplasia in patients with atypical adenoma risk increased 2 to 3 times, with statistics Significance of learning. Adenomas larger than 1 cm, villous / mixed adenomas and severe dysplasia were significantly associated with carcinomatous or atypical dysplasia, with relative risks of 42 (18-9) , 8 1 (4 2 ~ 15 6) and 14 4 (50 ~ 41 3). Compared with patients with mild dysplasia, less than or equal to 1cm adenoma, patients with atypical hyperplasia, patients with more than 1cm adenoma had a relative risk of developing synchronous rectal cancer of 37 (78-747) . Conclusion The risk of rectal heterosexual adenoma is closely related to the pathological features of primary adenomas. Therefore, they should be closely monitored after excision of primary adenomas in high-risk group of adenomas.