黏膜下层浸润证据在结直肠癌术前肠镜活检病理诊断中的意义  

The significance of invasion of submucosa in the pathological diagnosis of colonoscopic biopsy of colorectal cancer

作　　者：卫旭彪[1] 高显华[1] 王颢[1] 傅传刚[1] 郑唯强[2] 郑建明[2] 

机构地区：[1]第二军医大学附属长海医院肛肠外科,上海200433 [2]第二军医大学附属长海医院病理科,上海200433

出　　处：《中国实用外科杂志》2012年第1期92-96,共5页Chinese Journal of Practical Surgery

基　　金：上海市科学技术委员会课题--"大肠癌诊疗规范的研究"(No.07DZ19505)

摘　　要：目的回顾性研究结直肠癌的术前肠镜活检标本中能否发现黏膜下层浸润证据与肿瘤临床病理学以及肠镜取材特点间的关系。方法对第二军医大学附属长海医院2007年1月至2008年12月收治的结直肠癌病例相应的肠镜活检标本石蜡切片进行回顾性阅片,观察是否具有黏膜下层浸润证据,利用卡方检验、t检验以及logistic回归分析对肿瘤临床病理学特点与能否在活检标本中发现黏膜下层浸润证据的关系进行统计学分析。结果 321例结直肠癌病例中,共216例(67.3%)可以发现黏膜下层浸润,单因素分析显示活检组织块直径较小的病例(P=0.042)、黏液腺癌(P=0.003)、高级别肿瘤(P=0.001)、淋巴结阳性的病例(P=0.011)以及深层次浸润病变(P=0.092)中发现黏膜下层浸润证据的比例显著下降,多因素回归分析显示高级别肿瘤(OR2.155,95%CI1.081～4.296,P=0.029),以及活检组织直径较小的病例(OR1.944,95%CI1.149～3.290,P=0.013)与活检组织中无法确定黏膜下层浸润相关。结论对于临床上高度怀疑恶性的结直肠肿瘤,虽然肠镜活检标本中未发现黏膜下层浸润,不能简单的诊断为高级别上皮内瘤变,应怀疑为晚期或者恶性程度较高的病变。Objective To investigate the clinicopathologic features that are associated with the un-identification of invasion of suhmucosa（ISM） in biopsy specimen of colorectal cancer. Methontls Colorectal cancer patients treated in Changhai Hospital from January 2007 to December 2008 were enrolled in the study. Biopsy specimens of colorectal cancers were re-evaluated by two senior pathologists. Clinicopathologic features were analyzed by univariate and multivariate analyses to identify the risk factors of un-identification of ISM in biopsy specimen. Results Of the 321 cases of colorectal cancers included into the study, 216 （67.3%） were diagnosed as eoloreetal cancer （with identification of ISM） by biopsy-based pathological examination. The results of univariate analysis indicate that colorectal cancer with smaller biopsy specimen （P= 0.042）, mucinous adenocarcinoma （P= 0.003）, higher tumor grade （P= 0.001）, lymph node metastasis （P =0.011） and deeper invasion （P=0.092） were less likely to be associated with identification of ISM. Multivariate logistic regression analysis revealed that eolorectal cancers with higher tumor grade （OR 2.155, 95% CI 1.081-4.296, P =0.029）, and smaller biopsy specimen （OR 1.944, 95% CI 1.149-3.290, P =0.013） were less likely to he associated with identification of ISM. Conclusion Clinical suspected malignant lesion without identification of ISM in biopsy specimen is highly predictive of more advanced or aggressive colorectal cancer.

关 键 词：高级别上皮内瘤变 黏膜下层浸润 肠镜活检 病理 结直肠肿瘤 

分 类 号：R6[医药卫生—外科学]