Brady P G, Straker R J, McClave S A, Nord H J, Pinkas M, Robinson B E
Department of Medicine, University of South Florida, Tampa.
Gastrointest Endosc. 1993 Jul-Aug;39(4):481-5. doi: 10.1016/s0016-5107(93)70155-8.
Diminutive polyps are frequent findings on screening flexible sigmoidoscopy. To determine the significance of distal diminutive polyps, we conducted a prospective study of 162 asymptomatic, average-risk subjects who were 50 years of age or older. Subjects were divided into four groups: 42 control subjects with no polyps in the rectosigmoid, 66 subjects with at least one diminutive adenoma in the rectosigmoid, 12 subjects with a mixed hyperplastic-adenomatous polyp in the rectosigmoid, and 42 subjects with only hyperplastic polyps in the rectosigmoid. Total colonoscopy was performed on all subjects. The prevalence of proximal adenomas was 42% in the adenoma group, 25% in the mixed group, 14% in the hyperplastic group and 12% in the control group. The prevalence of proximal adenomas was significantly higher (p = 0.006) in the adenoma group as compared with the control and hyperplastic groups. Increasing age was associated with an increased prevalence of proximal adenomas. Nearly two thirds of those over 65 years of age with distal diminutive adenomas had proximal colonic neoplasms. These results indicate that diminutive rectosigmoid adenomas are good markers for proximal neoplasms. Rectosigmoid hyperplastic polyps are not associated with an increased prevalence of proximal neoplasms. Total colonoscopy is not indicated if hyperplastic polyps are the only finding on flexible sigmoidoscopy.
在筛查性乙状结肠镜检查中，微小息肉是常见的发现。为了确定远端微小息肉的意义，我们对162名年龄在50岁及以上、无症状、平均风险的受试者进行了一项前瞻性研究。受试者被分为四组：42名直肠乙状结肠无息肉的对照受试者，66名直肠乙状结肠至少有一个微小腺瘤的受试者，12名直肠乙状结肠有增生性腺瘤混合息肉的受试者，以及42名直肠乙状结肠仅有增生性息肉的受试者。对所有受试者进行了全结肠镜检查。腺瘤组近端腺瘤的患病率为42%，混合组为25%，增生组为14%，对照组为12%。与对照组和增生组相比，腺瘤组近端腺瘤的患病率显著更高（p = 0.006）。年龄增加与近端腺瘤患病率增加相关。65岁以上患有远端微小腺瘤的受试者中，近三分之二有近端结肠肿瘤。这些结果表明，直肠乙状结肠微小腺瘤是近端肿瘤的良好标志物。直肠乙状结肠增生性息肉与近端肿瘤患病率增加无关。如果在乙状结肠镜检查中仅发现增生性息肉，则无需进行全结肠镜检查。
