肠镜诊治大肠腺瘤癌变的临床价值  

ENDOSCOPIC DIAGNOSIS AND TREATMENT FOR INVASIVE CARCINOMA IN COLORECTAL ADENOMA

作　　者：何国杰[1] 姚礼庆[1] 高卫东[1] 周平红[1] 徐美东[1] 梁正[2] 

机构地区：[1]上海复旦大学附属中山医院普外科,200032 [2]南京医科大学附属淮阴第一医院普外科

出　　处：《中国内镜杂志》2001年第6期14-15,共2页China Journal of Endoscopy

摘　　要：目的 :探讨肠镜下大肠腺瘤的分布、大小、形态、病理特征与腺瘤癌变的关系及其诊治方法。方法 :选择80 4例病理证实为大肠腺瘤或腺瘤癌变的病例 ,分析大肠腺瘤大小、位点、基蒂特点和组织学特征对腺瘤癌变的影响。结果 :发现 80 4例共 112 6枚大肠腺瘤 ,腺瘤癌变 46例 (4 6枚 ) ,癌变发生率 4.1%。直肠、乙状结肠腺瘤 897枚 ,占腺瘤总数的 79.7% ,其中癌变腺瘤 39枚 ,占癌变腺瘤总数的 84.8%。直径大于 2 .0cm的腺瘤癌变率 17.2 % (2 6 / 15 1) ,1.0～ 2 .0cm腺瘤癌变率为 5 .5 % (15 / 2 71)。广基腺瘤癌变率为 11.5 % (2 6 / 2 2 6 ) ,短蒂或亚蒂者为 3.1% (18/ 5 74)。绒毛状腺瘤癌变率 2 2 .1% (2 1/ 95 ) ,管状绒毛状腺瘤 9.4% (15 / 15 9) ,管状腺瘤 1.1% (10 / 872 )。结论 :直肠、乙状结肠是大肠腺瘤及腺瘤癌变的好发部位 ,直径大于 2 .0cm腺瘤、广基腺瘤、绒毛状腺瘤和管状绒毛状腺瘤有较高的癌变危险性。积极治疗大肠腺瘤是防治大肠癌的有效措施之一。Objective:To study the relationship between colorectal adenomas and invasive carcinomas in colorectal adenoma in the endoscopic morphosis,site,size,pathological characteristics, and methods of diagnosis and treatment.Method:804 cases with colorectal adenomas and invasive carcinomas in adenoma proved pathologically were analyzed to investigate the influence of size,site,base characteristics and histologic type on the risk of invasive carcinoma in colorectal adenoma.Results:Overall,1126 adenomas were found,of which 46(4.1%) were invasive carcinomas in colorectal adenoma.897/1126 (79.7%) adenomas were found in rectum and sigmoid,of wihch 39/46(84.8%) were invasive carcinomas in adenoma.The malignancy rate in the adenomas larger than 2.0cm in diameter (17.2%) is higher than that betweeen 1.0cm and 2.0cm (5.5%).The malignancy rate of sessile adenomas (11.5%) is higher than that of pedunculated ones.The malignancy rate in villous,tubulovillous and tubular adenomas is 22.1%,9.4% and 1.1% respectively.Conclusions:Colorectal adenomas and invasive carcinomas in colorectal adenoma tend to be located in the rectum and sigmoid.The adenomas larger than 2.0cm,sessile,villous or tubulovillous have higher risk of developing invasive carcinoma in colorectal adenoma.Early diagnosis and treatment for colorectal adenomas by colonoscopic polypectomy is an efficient technique to prevent colorectal cancer.

关 键 词：大肠腺瘤 腺瘤癌变 结肠镜 

分 类 号：R735.340.5[医药卫生—肿瘤] R730.49[医药卫生—临床医学]