大肠侧向发育型肿瘤的内镜诊断与治疗  

Endoscopic diagnosis and treatment of colorectal laterally spreading tumors

作　　者：盛剑秋[1] 晨智敏[1] 李爱琴[1] 闫伟[1] 余东亮[1] 张英辉[1] 苏惠[1] 田素丽[1] 崔新娟[1] 韩英[1] 李世荣[1] 

机构地区：[1]北京军区总医院消化内科,100700

出　　处：《中华消化内镜杂志》2006年第4期248-251,共4页Chinese Journal of Digestive Endoscopy

基　　金：北京市科技计划项目基金资助(H020220020610);北京市自然科学基金资助(7062064)

摘　　要：目的观察大肠侧向发育型肿瘤(LST)的大体形态、隐窝开口及其与病理组织学的相关性;评价内镜下黏膜切除术(EMR)及氩离子凝固术(APC)联合治疗 LST 的疗效。方法应用黏膜染色技术对42例(45个病灶)大肠侧向发育型肿瘤隐窝开口形态观察,并进行 EMR 或内镜下分片黏膜切除(EPMR)及 APC 治疗,切除的标本进行病理组织学检查,术后随访。结果 2450例结直肠瘤中发现 LST 42例(45个病变),占1.7%;该42例中9例有家族性大肠肿瘤史,占21.4%。45个 LST病变中颗粒均一型、结节混合型、扁平隆起型和假凹陷型分别为26.7%,28.9%,40.0%和4.4%;其中管状腺瘤20个,绒毛管状腺瘤23个,锯齿状腺瘤(Serrated 腺瘤)2个,中度以上异型增生64.4%(29个),局部癌变11.1%(3个 m 癌,2个 sm 癌)。病理诊断的23个绒毛管状腺瘤中Ⅳ型隐窝开口20个,Ⅳ型隐窝开口与病理诊断符合率为86.9%(20/23)。3个病变行外科手术治疗,42个病变在内镜下治疗,经3个月～6年随访,除1例 sm2癌外科手术后发生肝转移死亡外,其余病变均治疗成功。结论观察 LST 的大体形态、隐窝开口改变和“非提起征”改变,有助于在内镜下正确估计病变的组织学改变和黏膜下浸润深度,从而指导选择正确的治疗方案,EMR 或 EPMR 联合 APC 治疗 LST 安全、有效,长期随访观察疗效可靠。Objective To observe the general shape and pit patterns of the laterally spreading tumors （LST） as well as their relationship with pothohistology ; to evaluate the therapeutic effect of endoscopic mueosal resection （EMR） associated with argon plasma coagulation （APC）. Methods Forty two patients （45 lesions） were treated with EMR or endoscopic piecemeal mueosal resection （EPMR） associated with APC and had the mueosal lesions stained with 0. 3 % indigo carmine, then compared the mueosal pit patterns with pathologic diagnosis. A follow up study was made. Re.suits Out of 2450 eoloreetal cancer eases, 42（1.7% ） LST （45 lesions） were found;9 （21.4%） of them were hereditary non-polyposis eoloreetal cancer or familial adenomatous polyposis （ HNPCC or FAP, both are hereditary eoloreetal cancer syndrome）. Endoscopic classification： granular homogeneous type, 26. 7% ; nodular-mixed type, 28.9% ; fiat elevated type, 40. 0%0 ; and pseudo-depressed type, 4.4%. Pathological patterns ： tubular adenoma 20, tubulo-villous adenoma 23, serrated adenoma 2 and moderate to highly dysplasia 29 （ 64. 4% ） in which 5 lesions showed early malignant degeneration （ 3 intra-mueosal cancer and 2 submueosal cancer）. Of 23 tubulovillous adenomas with pathological diagnosis, 20 pits were pattern IV and the coincident rate of pit pattern and pathologieal diagnosis was 86.9% （ 20/23 ）. Of the 45 lesions, 3 were treated surgically and 42 endoseopieally.After 3 mothos -6 years follow up.the lesions healed completely but one patient（sm2） died of hepatic metastasis after surgery.Conclusion It is helpful to observethe shape,pit patterns and ＂non-lifting signs＂ of the LST in order to correctly evaluste the histological changes and submucosal infiltration depth of the tumors under endoscopy,subsequently to select the proper treatement.It is safe and effective to treat LST by EMR or EPMR combined with APC.

关 键 词：大肠 侧向发育型肿瘤 内镜黏膜切除术 氩离子凝固术 

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