大肠镜下高频电切术后肠壁损伤的组织病理学观察  

Histopathological changes of colorectal injury caused by endoscopic resection

作　　者：姜彦多 张丹[2] 王继红 刘光军[2] 金成兰[2] 

机构地区：[1]解放军第二○二医院病理科,沈阳110003 [2]解放军第二○二医院消化内科,沈阳110003

出　　处：《诊断病理学杂志》2000年第4期273-275,共3页Chinese Journal of Diagnostic Pathology

摘　　要：目的　观察大肠高频电切术所致的组织学损伤 ,阐明其组织病理学特征 ,为临床防治并发症提供有价值的参考资料。方法　采用组织病理学方法 ,观察了 34例手术切除大肠标本上的 47处内镜切除部位和内镜切除标本。结果　内镜切除标本的深度仅限于黏膜下层内 ,47处内镜切除部位的黏膜下层均有不同程度的病变 ,2 8处(5 9.6 % )可见肌层或浆膜层的电热损伤 ,常表现为内肌层肌组织坏死、内外肌层间出血或纤维化及浆膜损伤。病变大多是局灶性的 ,与黏膜下层的病变不连续 ,呈现“跳跃”式的分布。内镜切除部位有肌层或浆膜病变者 ,内镜切除标本的平均最大径大于没有肌层或浆膜病变者 (P <0 0 5 )。内镜切除标本最大径 <10mm时 ,也可见肌层或浆膜的损伤。结论　内镜切除术引起的无症状肠壁电热损伤并不少见 ,其出现与内镜切除标本的大小有关 ,内镜切除最大径 <10mm的组织也可导致电热损伤 。Objective To investigate the pathologic changes of colorectum duo to endoscopic resection (ER). Methods Forty-seven post-ER sites in 34 cases of surgically removed colorectal specimens and the previous ER biopsies were examined histopathologically. Results The depth of all the biopsies was restricted to the submucosa. All the post-ER specimens showed submucosal lesions in various degrees, in which 28 sites (59.6%) presented pathologic alterations in the muscular and serosal layers. The lesions consisted of muscular damages in the inner layer of the muscular propria, hemorrhage and fibrosis between the inner and outer layers of the muscular propria, and serosal reaction. The uneven distribution of submucosal inflammation and muscular damage were observed in most of the specimens. The average size of the biopsy specimens with pathologic changes was larger than the specimens without significant lesions. Conclusions Asymptomatic electrothermal injury associated with ER occurs frequently. Severity of the injury appears to be related to the size of the biopsy, but small biopsy (<10 mm in diameter) can also cause severe injury, even a full-thickness necrosis of the bowel.

关 键 词：大肠息肉样病变 大肠镜 高频电切术 肠壁损伤 

分 类 号：R735.34[医药卫生—肿瘤] R730.2[医药卫生—临床医学]