Nugent K P, Farmer K C, Spigelman A D, Williams C B, Phillips R K
St Mark's Hospital, London, UK.
Br J Surg. 1993 Dec;80(12):1618-9. doi: 10.1002/bjs.1800801244.
Twenty-four patients with familial adenomatous polyposis who had previously undergone prophylactic colectomy and had advanced duodenal polyposis were entered into a randomized trial to assess the effect of the non-steroidal anti-inflammatory drug sulindac on duodenal and rectal polyps. Polyp size and number were assessed by videotaped duodenoscopy (and rectoscopy in 14 patients) at entry and after 6 months of treatment; the tapes were compared by two assessors who were unaware of the randomization and the shuffled chronological order of the recordings. Mucosal cell proliferation was measured by in vitro incorporation of 5-bromo-2'-deoxyuridine. Sulindac therapy was associated with a reduction in epithelial cell proliferation in the duodenum (median labelling index (LI) 15.8 versus 14.4 per cent, P = 0.003) and a trend towards duodenal polyp regression (P = 0.12). In the rectum, cell proliferation showed a marked reduction (median LI 8.5 versus 7.4 per cent, P = 0.018), and significant (P = 0.01) polyp regression was seen. Rectal polyposis was less severe than that in the duodenum and responded more dramatically. Sulindac is a possible treatment for patients in whom rectal polyps have failed to show significant regression after ileorectal anastomosis and who are unsuitable for pouch surgery; it may be useful in early duodenal polyposis or as an adjunct after duodenal clearance.
24例曾接受预防性结肠切除术且患有进展期十二指肠息肉病的家族性腺瘤性息肉病患者进入一项随机试验，以评估非甾体抗炎药舒林酸对十二指肠和直肠息肉的影响。在入组时和治疗6个月后，通过录像十二指肠镜检查（14例患者还进行了直肠镜检查）评估息肉大小和数量；两名不知随机分组情况及录像顺序的评估人员对录像进行比较。通过体外掺入5-溴-2'-脱氧尿苷来测量黏膜细胞增殖。舒林酸治疗与十二指肠上皮细胞增殖减少相关（中位标记指数（LI）15.8%对14.4%，P = 0.003），且十二指肠息肉有消退趋势（P = 0.12）。在直肠，细胞增殖显著减少（中位LI 8.5%对7.4%，P = 0.018），息肉出现显著消退（P = 0.01）。直肠息肉病不如十二指肠严重，反应更显著。对于回肠直肠吻合术后直肠息肉未出现显著消退且不适合行储袋手术的患者，舒林酸可能是一种治疗方法；它可能对早期十二指肠息肉病有用，或作为十二指肠清除术后的辅助治疗。
