内镜下黏膜染色联合黏膜切除对大肠侧向发育肿瘤的诊断治疗  

Diagnosis and treatment of laterally spreading tumor of the large intestine by chromoendoscopy and endoscopic mucosal resection

作　　者：侯俊[1] 梁若玲[1] 温瑞英[1] 李静娴[1] 何远琴[1] 

机构地区：[1]佛山市第二人民医院消化内科,528000

出　　处：《现代消化及介入诊疗》2006年第2期79-81,共3页Modern Interventional Diagnosis and Treatment in Gastroenterology

摘　　要：目的探讨普通电子肠镜下靛胭脂黏膜染色联合黏膜切除对大肠侧向发育型肿瘤及早期大肠癌的临床诊治价值。方法对3860例肠镜检查中发现的肠腔黏膜隆起、红斑、表面粗糙不平、血管纹理消失、肠黏膜无名沟中断等可疑黏膜病灶,行镜下喷洒0.4%靛胭脂黏膜染色,对染色发现的大肠侧向发育型肿瘤,观察病灶大小并进行形态分型,病灶黏膜可随充吸气变形者及黏膜下注射液体呈抬举征阳性者行内镜黏膜切除(EMR)21例、内镜下分片黏膜切除术(EPMR)11例、未能行黏膜切除者行活检6例,切除病灶黏膜送病理检查。结果发现LST病灶38例,检出率为0.98%。其中,颗粒均一型18个(46.6%)、结节混合型10个(25.9%)、平坦隆起型7个(18.1%)、假凹陷型3个(7.8%)。病变分布:直肠15个(39.5%),乙状结肠8个(21.0%),降结肠5个(13.2%),横结肠4个(10.5%),升结肠3个(7.9%),回盲部3个(7.9%)。病理检查:38例LST病灶中早期癌5例,检出率为13.2%,进展期大肠癌2例(5.2%),良性腺瘤31(81.6%)。结论普通电子肠镜下对大肠黏膜可疑病灶靛胭脂染色能够有效发现大肠LST病灶,联合镜下黏膜切除对早期大肠癌诊断和防治具有较高的临床价值。Objective To evaluate the clinical value of the diagnosis and treatment for laterally spreading tumor in the large intestine and early colorectal cancer by chromoendoscopy and endoscopic mucosal resection. Methods 3,860 patients were examined in our hospital by endoscopic chromoscopy during the period from June 2000 to June 2005. Once the lesions including enteric cavity mucosal protrusion, erythema, rough, interruption of the capillary network and the mucosal innominate grooves were detected, indigo carmine （0.4%） was sprayed onto the surface of the lesion in order to outline the size and morphological type by enteroscope. The submucosal tumors were confirmed by insufflation and deflation method or injection of saline into the submucosa. 21 lesions were treated with endoscopic mucosal resection （EMR） technique, Ⅱ lesions were treated with piecemeal EMR method, 6 lesions were performed endoscopic mucosal biopsy. All specimen were checked by pathologist. Result 38 lesions of LST were found, the detection rate was 0.98%. 18 lesions were classified into granular homogeneous type （46.6%）, 10 lesions into nodular mixed type （25.9%）, 7 lesions into even protrusive type（18.1%） and 3 lesions into false concavity type（7.8%）. 15 LST lesions was in the rectum, 8 in the sigmold colon, 5 in the descending colon, 4 in the transverse colon, 3 in the ascending colon and 3 in the ileocecal junction. The pathological diagnosis revealed that 5 lesions showed early malignant change （3 intramucosal cancer and 2 submucosal cancer）. The detection rate of early colorectal cancer in all LST was 13.2%, in which 2 lesions were in progressive stage, 31 lesions were innocence adenoma （22 lesions were villous adenoma, 9 lesions were tubular adenomas）. Conclusion LST has a close relationship with colorectal cancer. Endoscopic mucosa chromoscopy is effective to detect LST. EMR or EPMR may be considered as a good treatment for early colorectal cancer.

关 键 词：侧向发育型肿瘤 黏膜染色 内镜黏膜切除 早期大肠癌 

分 类 号：R735.34[医药卫生—肿瘤] R737.9[医药卫生—临床医学]