腸息肉介入治療后復發危險因素的Logistic回歸分析

宜都市第一人民醫院消化內科，湖北 宜都 443300

【Abstract】ObjectiveTo investigate the risk factors of the recurrence after interventional treatment of intestinal polys.MethodsOne hundred and thirty-six cases of adenomatous polyps were selected, all taken the endoscopic intestinal polyps electrocoagulation surgery. Patients were divided into relapse group (n=52) and non-recurrence group (n=84) according to the results of the follow-up. The general data (gender, age, the number of intestinal polyps, the size of intestinal polyps, the location of intestinal polyps, histological types) of the relapse group and non-recurrence group were compared, and multivariate Logistic regression analysis was performed. TheROCcurve was used to predict the value of the above factors in predicting the risk of the recurrence after interventional treatment of intestinal polys.ResultsThere was no significant difference in the location of intestinal polyps between two groups (P>0.05). In the relapse group, the proportion of male, age ≥60 years old, the number of intestinal polyps ≥3, the size of intestinal polyps ≥2 cm, villous adenoma or villous tubular adenoma (67.31%, 69.23%, 63.46%, 59.62%, 46.15%) were significantly higher than those in the non-recurrence group (48.81%, 45.24%, 44.05%, 35.71%, 21.43%) (P<0.05). Male, age ≥60 years old, the number of intestinal polyps ≥3, the size of intestinal polyps ≥2 cm, villous adenoma or villous tubular adenoma were the risk factors for relapse after interventional treatment of intestinal polyps (P<0.05). The sensitivity of sex, age, number of intestinal polyps, size of intestinal polyps, and histological types to predict postoperative recurrence were 0.467, 0.538, 0.515, 0.610 and 0.563, while the specificity were 0.643, 0.714, 0.750, 0.786 and 0.857.ConclusionMale, age ≥60 years old, the number of intestinal polyps ≥3, the size of intestinal polyps ≥2 cm, histological type of villous adenoma or villous tubular adenoma of the intestinal polyps have higher risk of recurrence after interventional treatment. It can adjust the follow-up program combined with the actual situation of patients to reduce the recurrence rate.

【Keywords】 Intestinal polyps; Interventional treatment; Recurrence; Risk factors; Logistic regression analysis

腸息肉為常見腸道病變，據報道，腸道病變具有腺瘤到腸癌的序貫表現，腸息肉已被認為是腸癌癌前病變。研究表明，我國腸癌發病率居各類型腫瘤發病率的第4位，死亡率則居第5位，及時發現腸息肉并予以有效治療對于降低腸癌死亡率具有重要作用。腸息肉的臨床治療目前以介入治療為主，有研究顯示，腸息肉介入治療后復發風險較大，4年內復發率為15%～60%。也有報道表明，隨訪時間越長，腸息肉介入治療后的復發率越高，且部分患者發展為浸潤性腸癌。明確腸息肉介入治療后復發的危險因素并對患者進行術后定期隨訪對于預防術后復發、降低癌變幾率具有重要作用。本研究以136例腺瘤性腸息肉患者為例，采用多因素Logistic回歸分析明確腸息肉介入治療后復發危險因素，現報道如下。

1 資料與方法

1.1一般資料選取宜都市第一人民醫院2013年1月至2015年4月收治的136例腺瘤性腸息肉患者，男76例，女60例，年齡(62.89±7.88)歲(37～86歲)。納入標準：(1)病理證實為腺瘤性腸息肉；(2)行內鏡下腸息肉電凝電切術；(3)年齡>18歲。排除標準：(1)有家族性息肉病史者；(2)合并克羅恩病、炎癥性腸病、結直腸癌者；(3)合并血液系統疾病者。研究獲醫院倫理委員會批準，患者均簽署知情同意書。

1.2 方法

1.2.1 治療方法：所有患者均行內鏡下腸息肉電凝電切術：手術前1 d的夜間進流食，手術當天禁食，腸鏡操作前6 h左右讓患者服用復方聚乙二醇電解質散(加2 000 ml溫水，分4次服用，每次間隔30 min)。用藥……