[克罗恩病中被排除的直肠：发育异常的风险是什么？]
[Excluded rectum during Crohn's diseases: what is the risk of dysplasia?].
作者信息
Leteurtre E, Kosydar P, Gambiez L, Colombel J F, Quandalle P, Lecomte-Houcke M
机构信息
Service d'Anatomie et Cytologie Pathologiques A, Faculté de Médecine, CHRU, Lille.
出版信息
Gastroenterol Clin Biol. 1999 Apr;23(4):477-82.
OBJECTIVES
An excluded rectum may be at risk of carcinoma in the course of Crohn's disease. Surveillance of patients requires detection of dysplasia. The aim of our study was to determine the frequency of dysplasia from secondary proctectomy specimens in active rectal Crohn's disease.
METHODS
Twenty three patients (13 women and 10 men, median age 38 years) were studied. The median duration of rectal exclusion was four years. Detection of dysplasia relied upon histopathology. Immunohistochemistry with MIB-1 (Ki-67) and anti-p53 (clone DO7) antibodies was performed as well.
RESULTS
Frequency of dysplasia was 30%. This was low grade dysplasia, focally observed in proctectomy specimens. MIB-1 was positive on 46% of dysplastic cells. There was no expression of p53 protein.
CONCLUSIONS
These results must be taken into account for decision of secondary proctectomy, in patients having an excluded rectum for Crohn's disease, when ileorectal anastomosis is not possible. Rectal endoscopic surveillance is advisable with multiple biopsies according to focal distribution of dysplasia.
目的
在克罗恩病病程中，被旷置的直肠可能有发生癌变的风险。对患者进行监测需要检测发育异常情况。我们研究的目的是确定在活动性直肠克罗恩病患者中，二次直肠切除标本中发育异常的发生率。
方法
对23例患者（13例女性，10例男性，中位年龄38岁）进行了研究。直肠旷置的中位时长为4年。发育异常的检测依靠组织病理学检查。同时还进行了MIB-1（Ki-67）和抗p53（克隆号DO7）抗体的免疫组织化学检测。
结果
发育异常的发生率为30%。这是低级别发育异常，在直肠切除标本中呈局灶性观察到。MIB-1在46%的发育异常细胞上呈阳性。未检测到p53蛋白表达。
结论
对于因克罗恩病而直肠被旷置且无法进行回直肠吻合术的患者，在决定是否进行二次直肠切除时必须考虑这些结果。建议进行直肠内镜监测，并根据发育异常的局灶分布进行多次活检。
Zotero 插件