Gillespie P E, Chambers T J, Chan K W, Doronzo F, Morson B C, Williams C B
Gut. 1979 Mar;20(3):240-5. doi: 10.1136/gut.20.3.240.
A colonoscopy survey of 620 patients with 1049 colon adenomas showed a predominantly left-sided distribution (77%). Of these lesions 97% were amenable to endoscopic removal or ablation. Sixty per cent of patients presented with rectal bleeding as their major symptom. There was agreement between radiology and colonoscopy in only 62% of patients, as many of the studies were single contrast barium enemas, performed before referral. Forty-eight per cent of adenomas in our series were less than 1.0 cm in diameter. Of the larger adenomas (greater than 2.0 cm in diameter) 66% were situated in the sigmoid colon, and of those containing invasive carcinoma (4.8% of the total) an even higher percentage (94%) were in the sigmoid and low descending colon. With increasing polyp size, there was a greater predominance of villous elements and this was associated with a higher risk of malignant change than the more frequent and generally smaller tubular adenoma. Local colonoscopic excision alone is sufficient treatment for adenomas with malignant change unless they are poorly differentiated histologically and providing adequate resection is demonstrated. Twenty-eight patients treated in this way are alive without recurrence at periods from six to 62 months. Although 65% of patients had only one adenoma, and 90% three or less, there is a risk of developing other benign and malignant colon neoplasms and careful follow-up is required.
一项对620例患有1049个结肠腺瘤患者的结肠镜检查显示，病变主要分布在左侧（77%）。其中97%的病变适合内镜切除或消融。60%的患者以直肠出血为主要症状。由于许多研究是在转诊前进行的单对比钡灌肠，只有62%的患者的影像学检查结果与结肠镜检查结果一致。在我们的系列研究中，48%的腺瘤直径小于1.0厘米。在较大的腺瘤（直径大于2.0厘米）中，66%位于乙状结肠，而在那些含有浸润性癌的腺瘤中（占总数的4.8%），这一比例更高（94%），位于乙状结肠和降结肠下段。随着息肉大小的增加，绒毛成分占比更大，与更常见且通常较小的管状腺瘤相比，其恶变风险更高。对于发生恶变的腺瘤，除非组织学上分化差且未证明切除充分，否则单纯局部结肠镜切除就足够了。以这种方式治疗的28例患者在6至62个月期间存活且无复发。尽管65%的患者只有一个腺瘤，90%的患者有三个或更少腺瘤，但仍有发生其他良性和恶性结肠肿瘤的风险，需要密切随访。
