OBJECTIVE:Change in colon polyp size over time has not been well characterized. It has been inferred that some polyps will increase in size, leading to an increased risk of progressing to cancer, whereas other polyps may spontaneously regress. To develop a better understanding of the natural history of colon polyps, we prospectively investigated change in polyp size over a 2-yr period.

METHODS:Patients were enrolled if they had an endoscopically detected proximal rectal or sigmoid polyp measuring 3-9 mm. The index polyp site was then permanently marked with an adjacent India ink tattoo to allow definitive future localization of the polyp. Patients underwent flexible sigmoidoscopy at 6-month intervals, and at each examination, the polyp size was carefully measured with open biopsy forceps. After a maximum of 2 yr, each polyp was removed and the histology determined.

RESULTS:Thirty polyps were followed in 26 patients who completed the study. Twelve polyps were tubular adenomas (TA), one was tubulovillous, 14 were hyperplastic polyps (HP), two had no pathological diagnosis, and one was a leiomyoma. HP were more likely to decrease in size than were TA. Three polyps demonstrated fast growth rates (2-4 mm/yr), and all were TA. Two polyps were removed early because their size had reached 1 cm or more. Both of those polyps were TA. No polyps regressed completely during the 2 yr of the study; neither did we find consistent linear growth rates.

CONCLUSIONS:In contrast to prior reports, in this study, after polyps had been definitively localized with India ink, we observed no complete polyp regressions.

译文

目的:对结肠息肉大小随时间的变化尚无定论。已经推断出某些息肉的大小会增加,导致患癌症的风险增加,而其他息肉则可能自发地消退。为了更好地了解结肠息肉的自然病史,我们前瞻性研究了两年内息肉大小的变化。

方法:如果患者具有内窥镜检查,则入组检出近端直肠或乙状结肠息肉,大小为3-9毫米。然后将索引息肉部位永久性地标记上相邻的印度墨水纹身,以确保将来可以明确定位息肉。患者每6个月进行一次乙状结肠镜检查,每次检查时,均应使用开放式活检钳仔细测量息肉大小。最长2年后,将每个息肉切除并确定组织学。

结果:在完成研究的26例患者中,对30例息肉进行了随访。十二个息肉是肾小管腺瘤(TA),一个是肾小管性腺癌,十四个是增生性息肉(HP),两个没有病理诊断,一个是平滑肌瘤。 HP的尺寸比TA的尺寸更可能减小。三个息肉显示出快速的生长速度(2-4毫米/年),并且全部为TA。由于息肉的大小已达到1厘米或更大,因此较早切除了两个息肉。这些息肉都是TA。在研究的2年中,没有息肉完全消退。我们都没有找到一致的线性增长率。

结论:与先前的报告相比,在本研究中,在使用印度墨水对息肉进行了明确定位之后,我们没有观察到息肉完全消失。

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