大肠侧向发育型肿瘤临床意义及诊治  

Clinical significance and diagnosis &treatment of laterally spreading tumor of large

作　　者：姜泊[1] 刘思德[1] 智发朝[1] 潘德寿[1] 周丹[1] 万田谟[1] 周殿元[1] 

机构地区：[1]第一军医大学南方医院全军消化内科研究所,510515

出　　处：《现代消化及介入诊疗》2001年第4期25-28,共4页Modern Interventional Diagnosis and Treatment in Gastroenterology

摘　　要：背景:大肠侧向发育型肿瘤(LST)是指起源于大肠粘膜的一类隆起型病变,这类病变极少向肠壁深层垂直侵犯,而主要沿粘膜表面呈侧向浅表扩散,故称之为侧向发育型肿瘤。大肠侧向发育型肿瘤(LST)其病变形态和发生发展上有一定的特殊性,不同于一般的腺瘤,LST与大肠癌的关系密切,并已有动态观察表明LST病变可以在3年内发展为进展期大肠肠癌。方法:应用放大内镜及粘膜染色方法在近一年共共检查2920名患者。结果:发现25例侧向发育型肿瘤,共26个病变。其中颗粒均一型11例,结节混合型15例,粘膜内癌3例,锯齿状肿瘤2例;病变最大为60X72mm,最小为11X12mm;11～20mm有6个;21～30mm:9个;31mm以上有11个病变。在26例病变中,腺管开口类型主要以IV型腺管开口为主,占61.54％(16/26);表现为V_A型腺管开口的LST的3例患者,病理诊断为粘膜内癌,7例表现为IIIL型腺管开口类型的病例,病理诊断为管状绒毛状腺瘤;26例病变全部在发现病变的同时或择期进行EMR或EPMR切除治疗。全部病例未发生任何出血或穿孔等并发症。结论:对LST的临床检出必须应用粘膜染色技术和放大内镜,对有肠道粘膜发红或粗糙、血管网不清或消失的征象必须进行粘膜染色,以发现病变。LST的腺管开口大多数表现为IV型或IIIL型,而IV型腺管开口多为绒毛状腺瘤,IIIL型腺管开口多为管状腺瘤,一但出现V型腺管开口则已经表明有癌变发生。Background: Laterally spreading tumor (LST) is a kind of prominent lesions originating from the large intestine mucosa, which mainly extend laterally, rather than vertically. The lesion form and the occurrence of LST have their own specificities, and are different from the common adenoma. LST has a close relationship with colorectal cancer. Some data about LST indicates that LST can develop cancer within three years. Methods: we examined 2920 patients with magnifying endoscope and mucosa staining from November, first 2000 to October 30, 2001.Results: There are 25 patients with LST, with 26 lesions, 11 for granular type, 15 for nodular-mixed type, and there are 3 patients with intramucosa carcinoma and 2 patients with serrated adenoma. The biggest lesion is 60×70mm, and the smallest 11×12mm. There are 6 within 11-20mm, 9 from 21 to 30 mm, 11 lesions exceeding 31mm in the diameter of 26 lesions. The pit patterns of the 26 lesions are mainly IV pit patterns, about 61.54% (16/26). The pathological diagnoses of 3 patients with V_A pit patterns LST are intramucosa carcinoma, and 7 patients with III_L pit patterns are tubulovillous adenoma. All of the 26 lesions are resected by EMR or EPMR.No complication occurred for the patients during treatment of EMR such as hemorrhage and perforation.Conclusion: Mucosa staining and magnifying endoscope is useful to detect LST We must pay more attention to those sign, such as mucosa with red. rough or mucosa with unclear or disappearing vasoganglion, it is necessary to stain the mucosa with indigocarmine spray to detect mocosa sign to find out flat tumor. Most pit patterns of LST are IV or III_L, and LST with IV pit patterns are mainly villous adenoma, III_L tubular adenoma, while LST with the V pit pattern has carcinomatous change.

关 键 词：腺管开口类型 LST 腺瘤 病变 L型 大肠侧向发育型肿瘤 粘膜染色 放大内镜 大肠癌 患者 

分 类 号：R735.34[医药卫生—肿瘤] R333.4[医药卫生—临床医学]