肠道息肉有良恶，你会分吗？
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">肠道息肉会变成肠癌吗？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">肠道息肉有良恶吗？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">大夫</span>写的诊断报告，<span style="color: black;">每一个</span>字都认识，</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">可是连起来不<span style="color: black;">晓得</span>说了啥？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">今天，<span style="color: black;">咱们</span>来叨叨肠道息肉！</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1肠道息肉<span style="color: black;">归类</span>——Paris<span style="color: black;">归类</span>美国结直肠癌多社会工作组（USMSTF）<span style="color: black;">颁布</span>的关于内镜下切除结直肠病变的<span style="color: black;">意见</span>中，<span style="color: black;">按照</span>Paris<span style="color: black;">归类</span>标准，结直肠病变可分为息肉型、非息肉型和溃疡型三大类，其中息肉型较为<span style="color: black;">平常</span>。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic3.zhimg.com/80/v2-4f20bef99645945492b4357db4b007ce_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">平常</span>的息肉在结肠镜下观察可分为<span style="color: black;">没</span>蒂（扁平，直接从粘膜层产生）或有蒂（<span style="color: black;">经过</span>纤维血管柄从粘膜延伸）（下图所示）。</p>临床上，有蒂结肠息肉发病率可能性较高；治疗的难易程度，有蒂结肠息肉治疗相对容易，<span style="color: black;">由于</span><span style="color: black;">没</span>蒂结肠息肉基底部较宽，操作困难；恶变的倾向，有蒂结肠息肉恶变程度较低，但<span style="color: black;">详细</span>结合的病理类型判断，综合<span style="color: black;">思虑</span>息肉<span style="color: black;">体积</span>、分化程度等。
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic1.zhimg.com/80/v2-fb5b4c4d62fc11195e3c51bf3d876f58_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2肠道肿瘤性息肉知多少？</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">结直肠息肉<span style="color: black;">按照</span>病变的可能性可分为肿瘤性和非肿瘤性，非肿瘤性息肉<span style="color: black;">包括</span>增生性、错构瘤性或炎症性等，<span style="color: black;">通常</span>恶变几率较低。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">肿瘤性结肠息肉<span style="color: black;">重点</span><span style="color: black;">表率</span>为腺瘤，腺瘤<span style="color: black;">一般</span>被认为是肠癌的典型前体，近85%-90%的散发性CRC<span style="color: black;">源自</span>于腺瘤。</p>解剖<span style="color: black;">发掘</span>，腺瘤<span style="color: black;">能够</span>在<span style="color: black;">全部</span>结肠中找到，腺瘤息肉的癌变与息肉的<span style="color: black;">体积</span>、形态以及病理的类型<span style="color: black;">相关</span>。<span style="color: black;">按照</span>世界卫生组织（WHO）<span style="color: black;">归类</span>系统分为管状、管状绒毛状或绒毛状，其中以管状腺瘤最为<span style="color: black;">平常</span>。
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic2.zhimg.com/80/v2-6bdab82f0c5daea2e2fd320aa16d0261_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">管状腺瘤</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">所有腺瘤都有不同程度的异型增生，从低级别到高级别不等。高度不典型增生、息肉内绒毛组织百分比<span style="color: black;">增多</span>和直径大于1 cm的息肉与恶性肿瘤风险<span style="color: black;">增多</span><span style="color: black;">相关</span>。 3肿瘤性息肉都会变成癌？管状腺瘤常有蒂，相较绒毛状腺瘤恶变几率较低，因其<span style="color: black;">拥有</span>更少的不典型性。</p>绒毛状腺瘤在显微镜下<span style="color: black;">拥有</span>长的手指状突起，<span style="color: black;">仅有</span>5-10%的肿瘤性息肉是绒毛状腺瘤。与管状腺瘤相比，绒毛状腺瘤<span style="color: black;">平常</span><span style="color: black;">没</span>蒂，<span style="color: black;">更易</span><span style="color: black;">显现</span>严重的异型性或不典型增生（癌前病变）。
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic3.zhimg.com/80/v2-d9a2721e5dad3b6db81a59bd3c68a64a_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">绒毛状腺瘤</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">大约10-25% 的息肉呈管状绒毛状，管状绒毛状腺瘤多<span style="color: black;">出现</span>于直肠与乙状结肠，属于癌前病变。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">传统上认为息肉中浸润性癌的<span style="color: black;">出现</span>率取决于其<span style="color: black;">体积</span>和组织学类型。在<span style="color: black;">少于</span>1 cm 的管状腺瘤中，相应的癌<span style="color: black;">危害</span><span style="color: black;">小于</span>5%，而在大于2 cm绒毛状腺瘤中可能达到 50%。 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">近期</span>的一项<span style="color: black;">科研</span><span style="color: black;">显示</span>，不大于 5 mm 的息肉<span style="color: black;">出现</span>高级别瘤变的<span style="color: black;">危害</span><span style="color: black;">少于</span> 1%，其<span style="color: black;">出现</span>癌症的<span style="color: black;">危害</span><span style="color: black;">能够</span>忽略不计。大于 5 mm的息肉被证明有 3% 的机会患癌，并且随着息肉<span style="color: black;">体积</span>的<span style="color: black;">增多</span>，机会<span style="color: black;">增多</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">Tips:</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">✅ 增生性、错构瘤性或炎症性息肉偏良性；</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">✅ 腺瘤被认为是肠癌的典型前体，其中绒毛状腺瘤<span style="color: black;">更易</span><span style="color: black;">显现</span>不典型增生（癌前病变）：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">✅ 腺瘤<span style="color: black;">体积</span>影响大，较小的管状腺瘤<span style="color: black;">危害</span>较低，绒毛状腺瘤超过<span style="color: black;">必定</span><span style="color: black;">体积</span>，<span style="color: black;">危害</span>大幅度<span style="color: black;">提升</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">参考文献：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1.Colorectal polyps and polyposis syndromes.</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2.Endoscopic management of colorectal polyps: From benign to malignant polyps.</p>4.Spotlight: US Multi-Society Task Force on Colorectal CancerRecommendations for Endoscopic Removal of Colorectal Lesions.为真大健康
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