71例结直肠锯齿状腺瘤内镜与病理学特征  

Endoscopic and histopathological features of serrated adenoma of large intestine:an analysis of 71 cases

作　　者：张婉雯[1] 任宝军[2] 童华生[1] 张亚历[1] 姜泊[1] 

机构地区：[1]南方医科大学南方医院消化病研究所,广州510515 [2]广东省顺德第一人民医院

出　　处：《中华胃肠外科杂志》2006年第3期250-252,共3页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨结直肠锯齿状腺瘤(SA)的内镜下形态和病理组织学特征。方法回顾性分析2002年1月至2005年7月南方医院消化内镜中心检出的71枚SA的内镜和病理资料。结果71枚SA中47枚为隆起型(无蒂23枚,亚蒂5枚,有蒂19枚),24枚为表面型(扁平16枚,侧向发育型8枚),平均大小分别为10.5mm和16.6mm,常见于直肠及乙状结肠。组织病理学上,管状、管状绒毛状和绒毛状SA分别为53、9和9枚;不典型增生程度,轻度47枚,中度22枚,2枚局部有癌变病灶。10mm以下的SA不典型增生程度较大于或等于10mmSA轻(P<0.01)。腺管开口(pit)分型的60枚SA中,Ⅳ型SA多由绒毛状腺体(64%)组成,ⅢL型SA多由管状腺体(68%)组成,但有40%的SA(24枚)表现为增生性息肉样的Ⅱ型,全部由管状腺体组成;腺体异型性Ⅱ型与ⅢL型相近而小于Ⅳ型息肉(P<0.05)。结论Ⅱ型pit的息肉可能为SA。SA具有肿瘤性息肉的一般特点,应视为一种新的可能性癌前病变。Objective To explore the endoscopic and histopathological morphology of large intestinal serrated adenomas（SA）. Methods The endoscopic and pathological data of 71 SA patients, diagnosed in the Digestive Endoscopy Center, Nanfang ＇Hospital from January 2002 to July 2005, were analyzed retrospectively. Results Forty-seven of the 71 serrated adenomas were protruded （sessile 23, semipedunculated 5, pedunculated 23） and 24 were superficial （fiat 16, laterally spreading 8）. The mean sizes of the protruded and superficial SA were 10.5 mm and 16. 6 ram, respectively, and both of them were frequently located in the sigrnoid and rectum. HistopathologicaUy, SA contained tubular glands in 53, tubulovillous glands in 9 and villous glands in 9 cases. Mild dysplasia was found in 47 SAs, moderate dysplasla in 22 SAs, and canceration focl in 2 SAs. The dysplasia of SAs（ 〈 10 mm） was significantly better than that of SAs（ ≥ 10 mm） （ P 〈 0. 01 ） . Most Ⅳ and ⅢL pit SAs presented villous glands（64% ） and tubular glands（68% ）, respectively. 40% of hyperplastic polyps-like SAs, composed of tubular glands, showed Ⅱpit pattern. Atypia inⅡ pit SAs was similar to that in Ⅲ L pit SAs, but was worse than that in Ⅳ pit SAs. Conclusion Polyps withⅡ pit pattern possiblly are SAs sometimes. SA with the common characters of neoplastic polyps, should be regarded as a new potential precancerous lesion.

关 键 词：锯齿状腺瘤 病理学 临床 结肠镜检查 

分 类 号：R735.3[医药卫生—肿瘤]