早期小肠镜干预对Peutz-Jeghers综合征患者的影响
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摘要
目的明确早期气囊辅助内镜(小肠镜)干预对Peutz-Jeghers综合征(Peutz-Jeghers syndrome,PJS)患者的影响。方法回顾性分析2008年1月—2018年1月期间于空军特色医学中心(原空军总医院)行小肠镜下治疗的PJS患者为研究对象(284例),将其按是否因该疾病行外科手术治疗分为外科手术组(198例)和非外科手术组(86例),分别以"首次小肠镜干预年龄是否14岁以下"和"有无家族史"为暴露因素,对2组患者进行病例对照研究。结果 14岁前首次行小肠镜治疗较14岁后对PJS患者行外科手术治疗有统计学意义(χ~2=16.277,P<0.05),14岁前行小肠镜干预起保护性作用,可降低PJS患者外科手术治疗风险[OR=0.297,95%CI(0.164～0.535)]。有无家族史对PJS患者是否行外科手术治疗差异有统计学意义(χ~2=7.329,P<0.05),有家族遗传史者外科手术风险较散发者低,家族史起保护性作用,降低了PJS患者外科手术风险[OR=0.485,95%CI(0.287～0.818)]。14岁前小肠镜干预和家族史这两个变量无明显关联性(χ~2=3.672,P>0.05)。结论 Peutz-Jeghers综合征患者行早期小肠镜干预可以有效降低外科手术风险。
Objective To analyze the effect of early balloon assisted enteroscopy on patients with Peutz-Jeghers syndrome(PJS).Methods The clinic data of 284 patients with Peutz-Jeghers syndrome treated with enteroscopy at Air Force Medical Center from January 2008 to January 2018 was retrospectively analyzed. These patients were divided into two groups: the surgical intervention group and non-surgical intervention group. "Undergoing enteroscopic intervention before 14 years old" and "family history" were chosen as exposure factors in this study, and statistical analysis was performed. Results The ?rst Enteroscopic treatment before 14 years old had statistical signi?cance compared with the surgical treatment after 14 years old(χ~2=16.277,P<0.05). The protective effect of Enteroscopic intervention before 14 years old can reduce the risk of surgical treatment for PJS patients [OR=0.297, 95%CI(0.164-0.535)]. There was signi?cant difference between family history and surgical treatment for PJS patients(χ~2=7.329,P<0.05). Patients with family history had lower surgical risk than sporadic patients. Family history played a protective role and reduced the surgical risk of PJS patients [OR=0.485, 95%CI(0.287-0.818)]. There was no signi?cant correlation between Enteroscopic intervention and family history before 14 years old(χ~2=3.672,P>0.05). Conclusion Early balloon assisted enteroscopic intervention on patients with Peutz-Jeghers syndrome can effectively reduce the risk of surgical operation.
Objective To analyze the effect of early balloon assisted enteroscopy on patients with Peutz-Jeghers syndrome(PJS).Methods The clinic data of 284 patients with Peutz-Jeghers syndrome treated with enteroscopy at Air Force Medical Center from January 2008 to January 2018 was retrospectively analyzed. These patients were divided into two groups: the surgical intervention group and non-surgical intervention group. "Undergoing enteroscopic intervention before 14 years old" and "family history" were chosen as exposure factors in this study, and statistical analysis was performed. Results The ?rst Enteroscopic treatment before 14 years old had statistical signi?cance compared with the surgical treatment after 14 years old(χ~2=16.277,P<0.05). The protective effect of Enteroscopic intervention before 14 years old can reduce the risk of surgical treatment for PJS patients [OR=0.297, 95%CI(0.164-0.535)]. There was signi?cant difference between family history and surgical treatment for PJS patients(χ~2=7.329,P<0.05). Patients with family history had lower surgical risk than sporadic patients. Family history played a protective role and reduced the surgical risk of PJS patients [OR=0.485, 95%CI(0.287-0.818)]. There was no signi?cant correlation between Enteroscopic intervention and family history before 14 years old(χ~2=3.672,P>0.05). Conclusion Early balloon assisted enteroscopic intervention on patients with Peutz-Jeghers syndrome can effectively reduce the risk of surgical operation.
引文
[1]Shacolevy R, Jasperson KW, Martin K, et al. Morphologic characterization of hamartomatous gastrointestinal polyps in Cowden syndrome, Peutz-Jeghers syndrome, and juvenile polyposis syndrome[J]. Hum Pathol, 2016, 49:39-48.
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[7]宁守斌,毛高平,唐杰,等.双气囊小肠镜对Peutz-Jeghers综合征的诊治研究[J].中国内镜杂志,2008, 14(5):467-470.
[8]宁守斌,毛高平,唐杰,等. Peutz-Jeghers综合征小肠息肉的双气囊小肠镜治疗[J].胃肠病学,2009, 14(8):465-468.
[9]Korsse SE, Dewint P, Kuipers EJ, et al. Small bowel endoscopy and Peutz-Jeghers syndrome[J]. Best Pract Res Clin Gastroenterol, 2012, 26(3):263-278.
[10]Beggs AD, Latchford AR, Vasen HF, et al. Peutz-Jeghers syndrome:a systematic review and recommendations for management[J]. Gut, 2010, 59(7):975-986.
[11]Rufener SL, Koujok K, Mckenna BJ, et al. Small bowel intussusception secondary to Peutz-Jeghers polyp[J].Radiographics,2008, 28(1):284-288.
[12]Bouraoui S,Azouz H,Kechrid H,et al.[Peutz-Jeghers'syndrome with malignant development in a hamartomatous polyp:report of one case and review of the literature][J].Gastroenterol Clin Biol,2008, 32(3):250-254.
[13]张卓超,宁守斌,毛高平,等.少儿Peutz-Jeghers综合征患者小肠息肉内镜治疗价值研究[J].中华消化内镜杂志,2016, 33(8):527-530.
[14]Vidal I, Podevin G, Le-Rhun M, et al. Follow-up and surgical management of Peutz-Jeghers syndrome in children[J]. J Pediatric Gastroenterol Nutr, 2009, 48(4):419-425.
[2]Jiang CY,Esufali S,Berk T,et al. STK11/LKB1 germline mutations are not identified in most Peutz-Jeghers syndrome patients[J]. Clin Genet,1999, 56(2):136-141.
[3]Mcgarrity TJ, Kulin HE, Zaino RJ. Peutz-Jeghers syndrome[J]. Am J of Gastroenterol, 2000, 95(3):596-604.
[4]Tomlinson IP, Houlston RS. Peutz-Jeghers syndrome[J]. J Med Genet,1997, 34(12):1 007-1 011.
[5]Sakamoto H, Yamamoto H, Hayashi Y, et al. Nonsurgical management of small-bowel polyps in Peutz-Jeghers syndrome with extensive polypectomy by using double-balloon endoscopy[J]. Gastrointest Endosc, 2011, 74(2):328-333.
[6]Gao H, van Lier MG, Poley JW, et al. Endoscopic therapy of small-bowel polyps by double-balloon enteroscopy in patients with Peutz-Jeghers syndrome[J]. Gastrointest Endosc, 2010, 71(4):768-773.
[7]宁守斌,毛高平,唐杰,等.双气囊小肠镜对Peutz-Jeghers综合征的诊治研究[J].中国内镜杂志,2008, 14(5):467-470.
[8]宁守斌,毛高平,唐杰,等. Peutz-Jeghers综合征小肠息肉的双气囊小肠镜治疗[J].胃肠病学,2009, 14(8):465-468.
[9]Korsse SE, Dewint P, Kuipers EJ, et al. Small bowel endoscopy and Peutz-Jeghers syndrome[J]. Best Pract Res Clin Gastroenterol, 2012, 26(3):263-278.
[10]Beggs AD, Latchford AR, Vasen HF, et al. Peutz-Jeghers syndrome:a systematic review and recommendations for management[J]. Gut, 2010, 59(7):975-986.
[11]Rufener SL, Koujok K, Mckenna BJ, et al. Small bowel intussusception secondary to Peutz-Jeghers polyp[J].Radiographics,2008, 28(1):284-288.
[12]Bouraoui S,Azouz H,Kechrid H,et al.[Peutz-Jeghers'syndrome with malignant development in a hamartomatous polyp:report of one case and review of the literature][J].Gastroenterol Clin Biol,2008, 32(3):250-254.
[13]张卓超,宁守斌,毛高平,等.少儿Peutz-Jeghers综合征患者小肠息肉内镜治疗价值研究[J].中华消化内镜杂志,2016, 33(8):527-530.
[14]Vidal I, Podevin G, Le-Rhun M, et al. Follow-up and surgical management of Peutz-Jeghers syndrome in children[J]. J Pediatric Gastroenterol Nutr, 2009, 48(4):419-425.