Yoo Tae Woo, Park Dong Il, Kim Young-Ho, Kim Hyun Soo, Kim Won Ho, Kim Tae Il, Kim Hyo Jong, Yang Suk-Kyun, Byeon Jeong-Sik, Lee Moon Sung, Jung Il Kwon, Chung Moon Kwan, Jung Sung-Ae, Jeen Yoon Tae, Choi Jai Hyun, Choi Hwang, Han Dong Soo, Song Jae Suk
Department of Internal Medicine, Kangbuk Samsung Hospital, Korea.
Hepatogastroenterology. 2007 Mar;54(74):418-21.
BACKGROUND/AIMS: Polypectomy is the current modality of choice to prevent benign colorectal adenoma from progressing to an invasive cancer. However, in cases of small colorectal adenoma, it remains unclear as to whether polypectomy is actually an effective treatment modality. We evaluated the clinical significance of polypectomy in cases of small colorectal adenomas, measuring less than 10 mm.
All colonoscopies were performed at 11 Korean tertiary medical centers, between July 2003 and March 2004. A total of 5996 colorectal adenomas were detected and divided into 5 groups according to their size (Group 1; 1-5 mm, Group 2; 6-7 mm, Group 3; 8-9 mm, Group 4; 10-19 mm, Group 5; more than 20 mm). The term 'advanced adenoma' refers here to tubular adenomas with diameters of at least 10 mm, or to tubulovillous, villous, or high-grade dysplasia, irrespective of size. 'Cancer' here is defined as the invasion of malignant cells beyond the muscularis mucosa.
As the sizes of the adenomas increased, the prevalence of advanced adenoma was also observed to increase. In Groups 2 and 3, the prevalence of tubulovillous or villous adenoma were higher than was expected (5.2% and 6.6%, p < 0.001). Interestingly enough, in Group 2, the prevalence of cancer was at least as high as in Group 4 (0.7% vs. 0.5%, p < 0.001).
In cases of small colorectal adenomas, measuring between 6 and 9 mm, the prevalence of cancer was at least as high as that seen in the cases of colorectal adenomas measuring between 10 and 19 mm. Therefore, small colorectal adenomas measuring between 6 and 9 mm should not be ignored, in order to decrease the prevalence of colorectal cancer.
背景/目的：息肉切除术是目前预防良性结肠直肠腺瘤进展为浸润性癌的首选治疗方式。然而，对于小的结肠直肠腺瘤病例，息肉切除术是否真的是一种有效的治疗方式仍不明确。我们评估了息肉切除术在直径小于10mm的小结肠直肠腺瘤病例中的临床意义。
2003年7月至2004年3月期间，在韩国11家三级医疗中心进行了所有结肠镜检查。共检测到5996个结肠直肠腺瘤，并根据其大小分为5组（第1组；1 - 5mm，第2组；6 - 7mm，第3组；8 - 9mm，第4组；10 - 19mm，第5组；大于20mm）。这里的“高级别腺瘤”是指直径至少为10mm的管状腺瘤，或指不论大小的绒毛状、绒毛管状腺瘤或高级别异型增生。这里的“癌”定义为恶性细胞浸润超过黏膜肌层。
随着腺瘤大小的增加，高级别腺瘤的患病率也随之增加。在第2组和第3组中，绒毛管状或绒毛状腺瘤的患病率高于预期（分别为5.2%和6.6%，p < 0.001）。有趣的是，在第2组中，癌的患病率至少与第4组一样高（0.7%对0.5%，p < 0.001）。
在直径为6至9mm的小结肠直肠腺瘤病例中，癌的患病率至少与直径为10至19mm的结肠直肠腺瘤病例中所见的患病率一样高。因此，为了降低结肠直肠癌的患病率，不应忽视直径为6至9mm的小结肠直肠腺瘤。
