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1、结直肠锣齿状息肉最新报道Updateonserratedpolypsofthecolorectuml妮惠崔山东大学加鲁医院(青岛)201403一19*简要介绍锦齿状病变专家共识推荐规范“增生性息肉(MVHP)与SSA/P的新认知*传统型锯齿状腺瘦(TSA)伴异型增生*简要介绍锯齿状病变专家共识推荐规范“2010年在Cleveland举行,由美国胃肠病学会(ACG)支持、美国国立卫生研究院(NIH)赞助名家组成员:,endoscopy,surgery,pathology,epidemiology,and/ormolecularaSpectsof“Serratedlesionsand/orserr
2、atedpolyposis.“经与会专家组讨论15年MEDLIAN文献,形成共识报告,目的是总结锯齿状息肉病理、分子病理和内镜特征,提高这种疾胁的意识,描述内镜特征,强调该疾序威府精确探查和完全切除的重要性,提供有关该病切除后处理的推荐规范。KeyconclusionsandrecommendationsoftheconsensusgroupPathology1Serratedlesionsofthecolorectum“Shouldbeclassifiedhistologicallyashyperplasticpolyp(HP),sessileserratedadenoma/polyp(SS
3、A/P)withorwithoutcytologicdysplasia,ortraditional“serrated“adenoma“(TSA).Exceptions“andsubcategoriesarediscussedinthetext.。CliniciansandpathologistswithininstitutionsshouldworkcollaborativelytoachieveacommonusageandunderstandingofterminologyofSerratedlesionis.2SSA/PandTSA_arepre-cancerouslesions,SSA
4、/Pistheprincipalprecursorofhypermethylatedcolorectalcancers(cancerswiththeCpGIslandMethylatorPhenotype-CIMP).Thispathwayoccursprimarilyintheproximalcolon.5“3SSA/IPisdistinguishedfromHPpathologicallybyfindingsofcryptdistortion,particularlyinthecryptbase,in_SSA/P,Werecommendthatasingleunequivocalarchi
5、tecturallydistorted,dilated,and/or“horizontallybranchedcrypt,particularly讪itisassociatedwithinvertedmaturation,issufficientforadiagnosisofSSA/P.Mostlargeserratedlesionsin_theproximalcolonareSSA/Ps.“4SSA/PWithcytologiealdysplasia记aioreadvancedlesionintheprogressiontoCancercomparedtoSSA/PWithoutcytolo
6、gical“dysplasia.Endoscopy5SSA/Pandhyperplasticpolypsintheproximalcolonhaveadistinctendoscopicappearance,Whichincludesa“mucuscap“,colorusuallysimilartonormalmucosa,andindistinctedges.Allcolonoscopistsshouldbeabletorecognizeserratedlesions.6Detectionofproximalcolonserratedlesionsbyindividualendoscopis
7、tsishighlycorrelatedwithadenomadetectiont.Pendingdevelopmentofspecificdetectiontargetsforproximalcolonserratedjesions,endoscopistsshouldmieasuretheiradenomadetectionratesasacheckonadequatedetectionofSerratedlesions。7Allserratedlesionsproximaltothesigmoidcolonshouldbefullyresectedduringcolonoscopy.Al
8、lserratedlesionsintherectosigmoidcolon5mminsizeshouldbefullyresected.Surveillance8SerratedpolyposisidefinedbytheWorldHealthOrganization(seetextfordetails).Patientswithserratedpolyposisrequirecloseendoscopicfollow-upWithcontrolofpolypburdenbyendoscopyorbysurgicalresectionifthenumber,sizeorlocationofs
9、erratedpolypsprecludesendoscopicresectionor诉acancerisdiagnosed.9FirstdegreerelativesofpatientswithSPSshouldundergocolonoscopyatage40or10yearsbeforetheageatdiagnosisofSPS。Colonoscopyshouldbeat5yearintervalsormoreoftenifpolypsarefound.10Therearefewlongitudinalobseryationalstudiesafterremovalofserrated
10、lesionsonWhichzecommendationsforpostpolypectomySurveillancecanbebased.RecommendatinsareImostlybasedonfeatafesqfsefratedlesionsforwWhichthere证evidenceofanassociationWithincreasedriskofcanceroradvanced“neoplasms,including:proximalcolonlocation,largesize,increasingnumber,andhistologicfeaturesincludingS
11、SA/Phistology.4lJCastroenierol2012,107(9:1315-1330.序言(introduction)d锯齿犬病变(senatedlesions)的真王二发病草尤其是结肠近段,可能高于先前的报道;相当数量的内镜医师漏掉了半数以上的锯齿状病变。流行病学尸解研究显示25-505的白种成人有一个及以步锦龄状病哀4“内镜检出率很低。锡齿状病变最常见于乙状结肠和直肠,其分布依据组织学类型变化,70-95%的锯齿状病变为HPs,左半结肠为主;SSA/Ps占5-25%,右半结肠为主,TSA少于SSA/Ps,左半结肠常见。9。结直肠锯齿状病变是1/3结直肠癌的前驱病变(癌前病变)。源于锯齿状病变的癌常发生于近端结肠。结直肠锯齿状病变根据WHO标准病理学分三大类,即增生性息肉(HPs)、广基型锯齿状腺瘤/恩肉(SSA/P)伴或不伴绍胞异型增生及传统型锯齿状腺瘤(TSA)。10
