ObjectiveTo investigate the clinical and pathological characteristics of advanced colorectal adenomatous polyps. MethodsPatients with colorectal adenomatous polyps diagnosed after colonoscopy in the Division of Gastroenterology of Zigong First People’s Hospital from January 2013 to March 2019 were selected. The patients were divided into advanced colorectal adenomatous polyps group (advanced group) and non advanced colorectal adenomatous polyps group (non advanced group), to analyze the location distribution, pathological type and the relationship with carcinogenesis of advanced colorectal adenomatous polyps. Results A total of 1 555 patients were included. There were 223 cases (14.34%) in the advanced group and 1 332 cases (85.66%) in the non advanced group. There was no significant difference in the distribution of canceration in postoperative pathological examination (P=1.000), but there was significant difference in other indexes between the two groups (P<0.05). The detection rate of high-grade intraepithelial neoplasia in the advanced group was higher in tubular adenoma than that in villous-tubular adenoma (41.18% vs. 13.74%; χ2=18.959, P<0.001). There was no significant difference in the detection rate of high-grade intraepithelial neoplasia between tubular adenoma and villous adenoma (41.18% vs. 25.00%; χ2=1.992, P=0.220). In the advanced group, 40 cases (17.94%) were at the right colon and 183 cases (82.06%) at the left colon. In the detection rate of high-grade intraepithelial neoplasia in the left colon, there was no significant difference between villous adenoma and villous-tubular adenoma (17.65% vs. 14.41%; χ2=2.801, P=0.094) or tubular adenoma (17.65% vs. 41.82%; χ2=3.289, P=0.088); the rate in tubular adenoma was higher than that in villous-tubular adenoma (41.82% vs. 14.41%; χ2=9.322, P=0.002). There was no significant difference in the detection rate of canceration among tubular adenoma, villous-tubular adenoma and villous adenoma in the advanced group (χ2=3.002, P=0.249). Conclusions At present, colorectal adenomatous polyps should be paid attention to. Endoscopic physicians should master the clinical and pathological characteristics of advanced colorectal adenomatous polyps, in order to raise the detection efficiency of advanced adenoma polyps and cancerous cases.
The results of 2389 patients exmained by colonofiverscope in past nine years are reported. Polyps were found in 561 cases, including 1256 polyps in the large intestine and 82 polyps in the terminal ileum. All 1299 polyps were removed with biopsy forceps. Pathology demonstrated that there were 406 adenomas, including 89 atypical hyperplasia and 23 cases with malignant change and 932 non-canerous polyps with 102 atypical hyperplasia. Since adenoma is seen to be a precancerous change, the polypectomy by colonofiberscope , ecpecially atypical hyperplastic polyps may decrease morbidity of large intestinal cancer. Cancer associated with adenoma may be as high as 51.28%, so the recrudescence of polyps may possibly be found even afer the cancer removal. These data showed that an early discovery of small malignant adenoma is key to improve efficiency.
ObjectiveTo systematically evaluate the efficacy and safety of computer-aided detection (CADe) and conventional colonoscopy in identifying colorectal adenomas and polyps. MethodsThe PubMed, Embase, Cochrane Library, Web of Science, WanFang Data, VIP, and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) comparing the effectiveness and safety of CADe assisted colonoscopy and conventional colonoscopy in detecting colorectal tumors from 2014 to April 2023. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias of the included literature. Meta-analysis was performed by RevMan 5.3 software. ResultsA total of 9 RCTs were included, with a total of 6 393 patients. Compared with conventional colonoscopy, the CADe system significantly improved the adenoma detection rate (ADR) (RR=1.22, 95%CI 1.10 to 1.35, P<0.01) and polyp detection rate (PDR) (RR=1.19, 95%CI 1.04 to 1.36, P=0.01). It also reduced the missed diagnosis rate (AMR) of adenomas (RR=0.48, 95%CI 0.34 to 0.67, P<0.01) and the missed diagnosis rate (PMR) of polyps (RR=0.39, 95%CI 0.25 to 0.59, P<0.01). The PDR of proximal polyps significantly increased, while the PDR of ≤5 mm polyps slightly increased, but the PDR of >10mm and pedunculated polyps significantly decreased. The AMR of the cecum, transverse colon, descending colon, and sigmoid colon was significantly reduced. There was no statistically significant difference in the withdrawal time between the two groups. Conclusion The CADe system can increase the detection rate of adenomas and polyps, and reduce the missed diagnosis rate. The detection rate of polyps is related to their location, size, and shape, while the missed diagnosis rate of adenomas is related to their location.
Objective To investigate the features of extracolonic carcinoma spectrum in Northeast Chinese with hereditary nonpolyposis colorectal cancer. Methods The extracolonic carcinoma spectrum’s characteristics of 85 families registered in strict conformity with the HNPCC Amsterdam criteriaⅡwere analyzed retrospectively. Results In the 85 HNPCC families， the tumorous patients were 509 cases，the primary tumors were 589 cases， among the total consisted of 219 cases of colon cancer， 91 cases of rectal cancer，and 279 cases of extracolonic cancer， the most common extracolonic carcinoma was lung cancer. Conclusions Extracolonic carcinoma is an important part of cancer spectrum in HNPCC family， and the common extracolonic carcinoma in Northeast of Chinese are lung cancer， gastric cancer， endometrial cancer， liver cancer， and esophagus carcinoma.
目的 探討經腹部彩色多普勒超聲（腹部超聲）聯合高頻超聲診斷良性膽囊息肉樣病變的價值。 方法 回顧性分析2008年1月－2011年11月121例腹部超聲聯合高頻超聲檢查提示為良性膽囊息肉樣病變、且有手術病理檢查結果的患者資料進行對照，以此評價經腹部超聲聯合高頻超聲對良性膽囊息肉樣病變的診斷準確性。 結果 121例術前經腹部超聲聯合高頻超聲診斷為良性膽囊息肉樣病變的患者，手術后病理檢查結果示膽固醇息肉62例（51.24%），炎性息肉27例（22.31%），腺瘤6例（4.96%），腺癌3例（2.48%），膽囊結石14例（11.57%），腺肌癥3例（2.48%），囊壁腺體結構紊亂3例（2.48%），黏膜下層軟結節3例（2.48%）。經腹部超聲聯合高頻超聲與手術后病理對比檢查，其診斷符合率為78.51%（95/121），誤診率為21.49%（26/121）。 結論 經腹部超聲聯合高頻超聲檢查對良性膽囊息肉樣病變診斷準確性較高，可為臨床預防膽囊癌前病變提供依據。Objective To investigate the value of abdominal color Doppler ultrasonography (CDU) combined with high-frequency ultrasonography (HFU) diagnosing benign polypoid lesion of gallbladder (B-PLG). Methods A total of 121 patients with B-PLG diagnosed by CDU combined with HFU between January 2008 and November 2011 were randomly selected. All of the patients underwent the surgery and had the record of surgical pathological examination results, which were compared with the results of the ultrasonography in order to evaluate the diagnostic accuracy of CDU combined with HFU for B-PLG. Results In 121 patients with B-PLG diagnosed by CDU combined with HFU before the surgery, cholesterol polyp was found in 62 (51.24%), infective polyp was found in 27 (22.31%), adenoma was found in 6 (4.96%), adenocarcinoma was found in 3 (2.48%), gallstones was found in 14 (11.57%), adenomyosis was found in 3 (2.48%), the wall structure gland disorder was found in 3 (2.48%), and submucosal soft nodules was found in 3 (2.48%) after the surgical pathological examination. Coincidence rate between CDU combined with HFU diagnosis and surgical pathological diagnosiswas 78.51% (95/121), and the misdiagnosis rate of CDU combined with HFU was 21.49% (26/121). Conclusion The accuracy of CDU combined with HFU diagnosing B-PLG is high, which can help to prevent precancerous lesion of gallbladder cancer.
ObjectiveTo observe the clinical effect of subretinal injection and intravitreal injection of conbercept in the treatment of polypoid choroidal vasculopathy (PCV). MethodsA prospective, randomized double-blind controlled study. From June 2022 to January 2023, 35 patients of 35 eyes with PCV diagnosed at Affiliated Eye Hospital of Nanchang University were included in the study. All patients were first-time recipients of treatment. Best corrected visual acuity (BCVA), optical coherence tomography (OCT), and indocyanine green angiography (ICGA) were performed in all affected eyes. BCVA was performed using an international standard visual acuity chart and converted to logarithmic minimum resolved angle (logMAR) visual acuity for statistical purposes. Enhanced depth imaging with OCT instrument was used to measure the macular retinal thickness (MRT), subfoveal choroidal thickness (SFCT), and pigment epithelium detachment (PED) height. Randomized numerical table method was used to divide the patients into subretinal injection group (group A) and vitreous cavity injection group (Group B), 18 cases with 18 eyes and 17 cases with 17 eyes, respectively. Comparison of age (t=0.090), disease duration (t=?0.370), logMAR BCVA (t=?0.190), MRT (t=0.860), SFCT (t=0.247), and PED height (t=?0.520) between the two groups showed no statistically significant difference (P＞0.05). The eyes of group A were given one subretinal injection of 10 mg/ml conbercept 0.05 ml (containing conbercept 0.5 mg), and subsequently administered on demand (PRN); eyes in group B were given intravitreal injection of 10 mg/ml conbercept 0.05 ml (containing conbercept 0.5 mg). The treatment regimen was 3+PRN. Lesions were categorized into active and quiescent according to the results of post-treatment OCT and BCVA. Active lesions were treated with intravitreal injection of conbercept at the same dose as before; stationary lesions were followed up for observation. BCVA and OCT were performed at 1, 2, 3, 6 and 9 months after treatment; ICGA was performed at 3, 6 and 9 months. BCVA, MRT, SFCT, and PED height changes before and after treatment were compared and observed in the affected eyes of the two groups. Independent sample t-test was used to compare between the two groups. ResultsWith the prolongation of time after treatment, the BCVA of the affected eyes in groups A and B gradually increased, and the MRT, SFCT, and PED height gradually decreased. Compared with group B, at 2, 3, 6, and 9 months after treatment, the BCVA of group A was significantly improved, and the difference was statistically significant (t=?2.215, ?2.820, ?2.559, ?4.051; P＜0.05); at 1, 2, 3, 6, and 9 months after treatment, the MRT of the affected eyes in group A (t=?2.439, ?3.091, ?3.099, ?3.665, ?5.494), SFCT (t=?3.370, ?3.058, ?3.268, ?4.220, ?4.121), and PED height (t=?3.460, ?4.678, ?4.956, ?5.368, ?6.396) were significantly reduced, and the differences were statistically significant (P＜0.05). No complications such as intraocular inflammation, high intraocular pressure, or vitreous hemorrhage occurred in any of the affected eyes during or after treatment. ConclusionCompared with the intravitreal injection of conbercept, the subretinal injection of conbercept can more effectively reduce the height of MRT, SFCT, PED height, and improve the visual acuity of the affected eyes with PCV.
