高清晰结肠镜下锯齿状腺瘤的形态学特点  

Colonoscopic characteristics of serrated adenomas

作　　者：刘揆亮[1] 司空银河 林香春[1] 吴静[1] 刘红[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院消化内科,北京市100038

出　　处：《世界华人消化杂志》2013年第36期4140-4145,共6页World Chinese Journal of Digestology

摘　　要：目的:探讨高清晰结肠镜白光及窄带成像(narrow band imaging,NBI)模式下锯齿状腺瘤(serrated adenoma,SA)的形态特点及其与增生性息肉(hyperplastic polyp,HP)的鉴别要点.方法:回顾性分析2010-03/2013-06在我院消化内科经高清晰结肠镜(CF-H260)检查诊断的结直肠SA的内镜下形态学特点(边界、外观、血管网形态),与按大小配对的HP进行比较.结果:共纳入来自35例患者的SA 50例,来自42例患者的HP 50例.SA位于右半结肠者多于HP(48%vs 36%),但差异没有统计学意义(P>0.05).SA大体形态呈Ⅱa及LST型者多于HP(11例vs 0例,P<0.05).SA中隐窝开口呈Ⅰ型者少于HP(25例vs 0例,P<0.001);呈Ⅱ型开大型(Ⅱ-O)者多于HP(22例vs 0例,P<0.001).SA中出现边界不清、形态不规整、积云样结构及息肉表面隐窝内点状血管网者比例均高于HP(P<0.001).Ⅱ-O型隐窝、积云样结构、边界模糊、形态不规整、隐窝内点状血管预测SA的敏感性分别为44%、92%、30%、66%和76%,特异性分别为98%、98%、98%、94%和92%;同时具备3种或3种以上形态学特点预测SA的敏感性为80%,特异性为100%.结论:SA具有一定的表面形态特点,高清晰非放大内镜下对病变表面形态特征的观察有助于SA与HP的鉴别.AIM： To investigate the morphologic features of serrated adenomas （SA） by regular high-reso- lution colonoscopy with narrow band imaging （NBI）. METHODS： A retrospective analysis was per- formed of the imaging data for patients with colorectal SA who underwent colonoscopy be- tween March 2010 and June 2013. A comparison of colonoscopic features was made between SA and hyperplastic polyps （HP） with comparable predicted diameter. RESULTS： A total of 50 SA from 35 patients and 50 HP from 42 patients were included. More SA were located in the right colon than in the left colon （48% vs 36%, P 〉 0.05）. Type IIa or later- ally spreading tumors （LST） were more com- monly seen in SA （P = 0.019） and II-O pit pattern was more commonly seen in HP （P = 0.000）. SAmore frequently showed the features of vague margins, irregular shape, cloud-like surface and dark bleeding spots in crypts （all P 〈 0.001）. The sensitivities of II-O pit pattern, cloud-like sur- face, indistinct border, irregular shape and dark bleeding spots in the crypts for predicting SA were 44%, 92%, 30%, 66% and 76%, respectively, and the specificities were 98%, 98%, 98%, 94% and 92%, respectively. The sensitivity and speci- ficity of the presence of three or more above characteristics for predicting SA were 80% and 100%, respectively. CONCLUSION： SA have certain colonoscopic features, which can aid in differentiating SA from HP.

关 键 词：锯齿状腺瘤 增生性息肉 结肠镜 

分 类 号：R735.3[医药卫生—肿瘤]