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关于结肠镜检测时发现腺瘤的系统文献研究及危险因素汇总分析

发布日期:2014-1-29 12:40:10 文章来源:Endoscopy 作者次数:1278
    关于结肠镜检测时发现腺瘤的系统文献研究及危险因素汇总分析
    V.  de Jonge1, J.  Sint Nicolaas1, M.  E.  van Leerdam1, E.  J.  Kuipers1,2, S.  J.  O.  Veldhuyzen van Zanten3
    2荷兰鹿特丹伊拉斯谟大学西校区医学院内科部
    3加拿大阿尔伯塔省埃德蒙顿市阿尔伯塔大学医院消化科
    背景与研究目的:结肠癌检查指南侧重于息肉切除后要进行监测,但建议监测时间间隔应有所不同。这个时间间隔也会影响到依从性。监测间隔是以危险因素为指标,因此我们来有目的地系统评估下结肠镜检测中腺瘤表现的危险因素。
    方法: 2009年9月前我们一直系统地进行相关文献检索,包括这篇为探讨指数特点的研究---报道了后续结肠镜检查结果及分层情况。我们使用随机效应模型计算得出相对危险度,且通过I2-统计法确定异质性。
    结果:共27个研究符合纳入标准,腺瘤检查结果中最重要的危险因素是以下结肠镜检查指数的存在:高危腺瘤(相对危险度:1.81),≥ 3 型腺瘤(相对危险度:1.64),尺寸10 mm(相对危险度:1.66),年龄≥60岁(相对危险度:1.65)。在相对危险度方面,绒毛状腺瘤高度不典型增生、近端腺瘤存在以及男性与其没有显著增加有关。研究设计时我们可以看到显著变化和大量异质性现象。
     
    结论:充分证据证明,若患者携带高危腺瘤、≥3腺瘤、腺瘤≥10mm,或者年龄超过60岁,那么腺瘤复发的风险会增加。现在关于增加腺瘤复发风险的其它基本表现,还没有确定证据。在中等或低质量研究中,良好执行和报道的研究是达到显著变化和一贯较低的相对危险度的必要条件。鉴于检测给患者和医疗服务人员带来大的影响,有需要进一步对腺瘤复发风险进行评估。
     
    Original article
    Endoscopy 2011; 43(7): 560-574
    DOI: 10.1055/s-0030-1256306

    © Georg Thieme Verlag KG Stuttgart · New York
     
     
    Systematic literature review and pooled analyses of risk factors for finding adenomas at surveillance colonoscopy
     
    V.  de Jonge1, J.  Sint Nicolaas1, M.  E.  van Leerdam1, E.  J.  Kuipers1,2, S.  J.  O.  Veldhuyzen van Zanten3
    1 Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
    2 Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
    3 Division of Gastroenterology, University of Alberta Hospital, Edmonton, Alberta, Canada

    Background and study aim: Colorectal cancer (CRC) screening guidelines recommend surveillance after polypectomy. There is variation in the surveillance intervals that are being advised. This variation also affects adherence. Surveillance intervals need to be based on risk factors at index. We therefore aimed to systematically review risk factors of adenoma findings at surveillance colonoscopy.

    Methods: A systematic literature search was performed up to September 2009. Studies that reported on follow-up colonoscopy findings with stratification for index characteristics were included. Pooled relative risks (RR) were calculated using random effects models, and heterogeneity was determined by means of the I2-statistic.

    Results: A total of 27 studies met the inclusion criteria. The most important risk factors for adenoma findings were the presence on index colonoscopy of the following: advanced adenomas (RR: 1.81), ≥ 3 adenomas (RR: 1.64), size ≥ 10 mm (RR: 1.66), and age ≥ 60 years (RR: 1.65). The presence of villous adenomas, high grade dysplasia, proximal adenomas, and male gender were associated with less profound increases in RR. Marked variation in study design and substantial heterogeneity between studies was observed.

    Conclusions: Convincing evidence exists that patients with advanced adenomas, ≥ 3 adenomas, adenomas ≥ 10 mm, or age ≥ 60 years have an increased risk of adenoma recurrence. The evidence for other baseline findings for an increased risk of adenoma recurrence is inconclusive. Marked variation and consistently lower RRs in studies of medium or low quality emphasize the necessity for well performed and well reported studies. Given the high impact of surveillance on patients and service providers, there is need for further assessment of the risk(s) of adenoma recurrence.

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