Luo Chenghua: how to check after resection of colorectal adenoma?2017-04-21 19:14:45 62 ℃
Author: Luo Chenghua
There are two kinds of potential risk of colorectal adenoma after resection of adenoma. The risk of recurrence increased from 5 in the year to the end of the 15 year after surgery in to 50%. The recurrence rate of 15 years after multiple adenomas was up to 80%. Rare recurrence after resection of benign tubular adenoma. Local recurrence occurred in villous adenoma and mixed adenoma. It is generally believed that the recurrence of the tumor is usually the removal of improper methods, resulting in tumor residues.
1049 cases of villous adenoma and villous adenoma were treated by Galandirk. The recurrence rate was about 8% after treatment:
The history of polyps, recurrence rate increased from 2 to 3 times;
The recurrence rate of rectal adenoma was 9 times higher than that of colon;
The recurrence rate was 10 times higher than that of local resection in patients with adenoma diameter greater than 4cm.
Colorectal adenomas have multiple tendencies, and multiple adenomas can occur at the same time. It has been reported that 30% of patients will develop new adenomas after treatment, and the recurrence rate is closely related to the number of adenomas in the first treatment. For the first time, the probability of recurrence was 28%, 41%, 60%, and four, respectively, with the number of adenomas in the group of 1, 2, 3, and more than 3. After recurrence of adenomas, there was still a recurrence of 1/3 in patients with adenomas. Potential risk of recurrence and recurrence of adenomas.
The incidence of colorectal cancer was 8 times higher than that of the normal population. Multiple adenomas (2 ~ 12) recurrence rate is high, the canceration rate is also high, according to statistics, the 1/14 for the year of 5, and the 10 and 15 years were 1/9.
Follow up after treatment is extremely important. The follow-up scheme proposed by Lambert can be used for reference.
Low risk group
A single, pedicled (or broadly but less than 2cm tubular adenoma) adenoma with mild or moderate dysplasia was resected with a colonoscopy. Second years after colonoscopy, such as microscopy negative, annual fecal occult blood test for every 3 years, repeat endoscopy, 3 consecutive negative endoscopy, endoscopy extended to 1 times every 5 years. If a diagnosis of adenoma was found, after treatment, according to the principle of follow-up after the first treatment.
Two, high risk group
Any of the following circumstances, is a high-risk patients:
The adenoma diameter over 2cm;
Villous or mixed adenoma;
Adenoma with severe dysplasia, or with carcinoma in situ and invasive adenoma.
The high-risk group of patients for the first time treatment and colonoscopy examination, 1 times a year, with 3 ~ 6 repeat examination is still negative, then the microscopic interval extended to 1 years; 2 consecutive negative microscopic examination, interval extended to 3 years; at the same time every year for fecal occult blood test. If a new adenoma was found in a certain microscopic examination, the treatment was still followed by the principle of follow up for the first time.
Follow up examination is the best way to use colonoscopy, because 30 ~ 50% can be removed immediately after the follow-up polyps. However, endoscopy has limitations, such as a group of 600 patients with endoscopy and X-ray examination, including 14 cases of > 7mm adenoma under endoscope misdiagnosis by pneumobarium double contrast examination found that misdiagnosis site in spleen, proximal rectal ampulla. Therefore, these two kinds of tests should be done at the same time. If colonoscopy examination.
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