Colonic_polyps结肠息肉.ppt

“ ” “ ” 结肠息肉 Non-neoplastic Mucosal polyps Submucosal polyps 处理：超声内镜诊断，必要可行活检 Neoplastic Adenomatous polyps About two-thirds of all colonic polyps are adenomas. Pedunculated polyp 0-Ip (A), sessile polyp 0-Is (B y C), flat polyp 0-IIb (D y F), superficial elevated with central depression 0-IIa + IIc (E) and excavated polyp 0-IIc (G y H) 癌变危险因素： Adenomatous polyps 1 cm high-grade dysplasia or 25 percent villous histology The number of adenomas, particularly three or more Rx: If a polyp is detected, we recommend colonoscopy to establish the histology, remove the polyp, and search for synchronous lesions? Hereditary Polyposis Syndromes 家族性腺瘤性息肉病FAP： APC基因：35岁前100%出现结肠息肉，50岁前结肠癌。 12岁起每1-2年筛查结肠镜，一旦发现息肉，结肠全切。 青少年息肉病综合征： 增加10%的结肠癌风险，息肉为错构瘤。 Cowden综合征： 癌变风险较小，与儿童直肠出血相关。 其它息肉、结肠癌相关综合征： Gardner syndrome：软组织肿物+结肠癌 Peutz-Jeghers syndrome：错构瘤性息肉+hyperpigmented spots Turcot syndrome：结肠癌+中枢神经系统肿瘤 另：Streptococcus bovis引起的心内膜炎与结肠癌相关。 5mm * 炎性假息肉，可能潜藏癌变。如果确定是炎性假息肉，最好不要动它，因血管丰富。 * Patients with small (≤10 mm) hyperplastic polyps confined to the rectum and sigmoid colon should be advised to undergo their nextscreening/surveillance?examination in 10 years. 更大的hyperplastic息肉有癌变风险，也需谨慎对待。 At least five serrated polyps proximal to the sigmoid colon, of which two or more are ≥10 mm Any number of serrated polyps proximal to the sigmoid colon in an individual who has a first degree relative with serrated polyposis syndrome Greater than 20 serrated polyps of any size, distributed throughout the colon 近端息肉需切除，平衡结肠镜切除与结肠切除的风险，每年1次结肠镜。亲属也需接受结肠镜 * “ ” “ ” 5mm * 炎性假息肉，可能潜藏癌变。如果确定是炎性假息肉，最好不要动它，因血管丰富。 * Patients with small (≤10 mm) hyperplastic polyps confined to the rectum and sigmoid colon should be advised to undergo their nextscreening/surveillance?examination in 10 years. 更大的hyperplastic息肉有癌变风险，也需谨慎对待。 At least five serrated polyps proximal to the sigmoid colon, of which two or more are ≥10 mm Any number of serrated polyps proximal to the sigmoid colon in an individual who has a first degree r