The Analysis Of Clinical Diagnosis And Treatment Of30Cases With Familial Adenomatous Polyposis

Objective：Discussing the clinical features, diagnosis, treatment and prognosis ofFamilial adenomatous polyposis(FAP),and enhancing to this sickness diagnosis level ofclinician, to avoid delayed diagnosis and treatment,improving the prognosis of patientsand improving the quality of survival.Methods: The clinical and pathological data of30patients with Familial adenomatouspolyposis were retrospectively analyzed from January1995to January2013in YijishanHospital of Wannan Medical College.All30patients had undergone surgical treatmentand had been clearly diagnosed with FAP by postoperative pathology. Here weretrospectively analyse the basic information of the patients,morbidity, clinicalsymptoms and manifestations, laboratory examination, and the result of the pathologyand immunohistochemical detection.In association with the imageological examination,endoscopy, therapies and the follow-up results.Results:1.General information:30patients from January1995to January2013inYijishan Hospital of Wannan Medical College were all treated after surgery anddiagnosed with Familial adenomatous polyposis by postoperative pathology.There are18males and12females in the30patients,age from21to58,with the median age of41.8patients diagnosed with cancer associated with colorectal adenomas(adenocarcinoma), with the median age of37.22patients had a family history of clearstatistical, accounting for73.3%,and8patients without a family history of statistics,accounting for26.7%. 2.Clinical features:Among the30patients in the research, the most common clinicalmanifestations were hematochezia (bright red or dark red, can be attached to the surfaceof the stool or mixed), diarrhea,mucous stool and the increased frequency of loosestools with or without abdominal pain,76.7%（23/30）.3patient had intestinalobstruction, accounting for10.0%（2patients had intussusception）.1patient had asignificant decrease in body weight, accounting for3.3%. And the left3patients did notappeal obvious clinical manifestations or had no positive signs,accounting for10.0%.3.Auxiliary examinations: All30patients were diagnosed with FAP by postoperativepathology. Colorectal lesions tips were found in2patients by CT virtualendoscopy,(only2patients had taken CTVC test).Colorectal polypoid lesions werefound by gastrointestinal radiography in27patients (11were found by pure bariumenema and16were found by colon double contrast barium examinations),the detectionrate was90.0%. Colorectal polyps were found in all30patients by electroniccolonoscopy, and the detection rate was100%. The pathology of endoscopic biopsyshowed all the30patients were adenoma, the same with postoperative pathologyresults.4.Postoperative pathology and immunohistochemical detection:All30patients had beenclearly diagnosed with adenoma by postoperative pathology(100%),20cases withtubular adenoma,accounting for66.7%, and10cases with tubulovillous adenoma orvillous adenoma in10cases, accounting for33.3%. The immunohistochemicaldetection results showed that HIF-1α were found in7of the8patients withadenocarcinoma and2of the rest22patients, VEGF were found in7of the8patientswith adenocarcinoma and3of the rest22patients. Accounting for Fisher exactprobability method,all the two P were less than0.05, the difference was statisticallysignificant.These showed that the expression of HIF-1α and VEGF were different inFAP with adenocarcinoma and FAP with no adenocarcinoma.5.Surgical methods and prognosis follow-up: All30patients had undergone surgical treatment,4of them had taken total colectomy and rectal mucosal stripping ileal pouchanal anastomosis (IPAA).17of them had taken total colectomy and ileorectalanastomosis,(IRA).9of them had taken total proctocolectomy and ileal analanastomosis（IAA）.The average operation time of IRA was3.5hours,the time ofrestoration of defecation was the first5-7days after operation,and the averagehospitalization time was12days.The average operation time of IPAA was5.5hours,thetime of restoration of defecation was the first6-10days after operation,and the averagehospitalization time was17days.The average operation time of IAA was3.0hours,thetime of restoration of defecation was the first4-7days after operation,and the averagehospitalization time was13days.During the follow-up, patients operated with IRAaveragely defecated8times per day.7of the17patients operated with IRA had adenomarelapsed, and after the adenoma resection,the defecation function recovered well andthey got good quality of life. Patients operated with IPAA averagely defecated5timesper day and had no complaints.Patients operated with IAA averagely defecated14times per day and some of them suffered perianal skin erosion and itching.And1patientoperated with IAA had occasional incontinence.So the quality of their life was worsethan the patients operated with IRA an IPAA.Conclusion:1. Familial adenomatous polyposis (FAP) can occur at any age，themedian age of about41years.There is no significant gender differences in thepathogenesis of FAP disease, and lack of specific clinical manifestations and serologicalexamination.2. Though gastrointestinal radiography (mainly for barium enema and Colon doublecontrast radiography) can not determine the nature on the lesions, but it can position thecolorectal polyps, the detection rate is high, it is of significance for the diagnosis ofFAP.3. With the use of digestive endoscopy we can not only observe the intestinal polypsdistribution range directly, also can be drawn for biopsy. The FAP positive rate and the detection accuracy rate of endoscopy is high，so it is the most important means ofdiagnosis of FAP.4. Though the IPAA operation is complex, long-time operation, complications, but it’spostoperative bowel control is good, at the same time, the eradication of the risk ofadenoma recurrence, this can improve the quality of life of patients, so it is the bestmethod for treating FAP adenoma with no cancerous.The IRA operation is relativelysimple, short-time operation,it can also retain part of rectal of patients, so it canimprove the quality of life of patients. And this is the main reason why IRA is thetreatment of choice.It’s suitable for patients whose rectal adenoma less than20,colonicpolyps less than1000, and someone can insist on regular review.