大肠侧向发育型肿瘤的内镜下分型与术后病理的相关性分析  

Correlation between endoscopic types and postoperative pathology of colorectal laterally spreading tumor:report of 165 cases

作　　者：彭学[1] 樊超强[1] 于劲[1] 杨歆[1] 邓磊[1] 谢霞[1] 廖忠莉[1] 聂绪彪 鲜承宏 刘恩[1] 杨仕明[1] 柏健鹰[1] 

机构地区：[1]第三军医大学新桥医院消化内科,重庆400037

出　　处：《第三军医大学学报》2014年第24期2489-2491,共3页Journal of Third Military Medical University

摘　　要：目的探讨大肠侧向发育型肿瘤(laterally spreading tumor,LST)内镜下的形态特征与病理学类型的关系,为治疗方式的选择提供依据。方法对我中心已行内镜手术或外科手术治疗的165例LST患者的临床资料进行回顾性分析(165例患者中,行内镜手术126例,外科手术22例)。结果 165例LST患者中,其中颗粒均一型(LST-G-H)9个,结节混合型(LST-G-M)124个,平坦隆起型(LST-NG-F)32个,假凹陷型(LST-NG-PD)0个。病理结果:癌变16个,低级别上皮内瘤变74个,高级别上皮内瘤变55个,息肉或腺瘤20个。结节混合型的高级别上皮内瘤变及黏膜下癌的发生率47.58%(59/124),高于颗粒均一型22.22%(2/9),但无显著差异;平坦隆起型的高级别上皮内瘤变及黏膜下癌的发生率31.25%(10/32)。总体比较:各亚型的病理类型比例之间无显著性差异(χ2=7.6301,P=0.2665),各亚型和病理类型在形态特点的分布比例也无显著性差异(P>0.05),但在颗粒型、非颗粒型中,LGIN、HGIN以及Cancer的分布具有显著差异(P<0.01)。结论大肠LST内镜形态具有一定的特殊性,与大肠癌的关系密切,多发生于直肠。其内镜下各分型的癌变率及恶性潜能均较高,需引起临床高度重视,及时采取相应治疗措施。Objective To evaluate the correlation between endoscopic morphology of the colorectal laterally spreading tumor（LST） with the pathological type.Methods The clinical data of 165 LST patients who had endoscopic or surgical treatment were retrospectively analyzed.In the 165 patients,126 underwent endoscopic treatment,and 22 underwent surgical treatment.Results Among the 165 cases,there were 9cases of homogeneous granular type（LST-G-H）,124 cases of nodular mixed type（LST-G-M）,32 cases of flat elevated type（LST-NG-F）,and 0 case of pseudo-depressed type（LST-NG-PD）.The pathology results showed that there were 16 cases of canceration,74 cases of low-grade intraepithelial neoplasia（LGIN）,55 cases of high-grade intraepithelial neoplasia（HGIN） and 20 cases of adenomatous polyp.The incidence of HGIN and submucosal carcinoma of LST-G-M was 47.58%（59 /124）,which was higher than that of LST-G-H（22.22%,2 /9）,but there was no significant difference.The incidence of HGIN and submucosal carcinoma of LST-NG-F was 31.25%（10 /32）.Totally,the proportion of pathological types of each endoscopic type of LST had no significant difference（Chi square = 7.6301,P = 0.2665）.The endoscopic type and pathological type had no significant difference in the morphological feature distribution proportion（P 〉 0.05）.But between the granular type and the non-granular type,the distribution difference of the LGIN,HGIN and cancer was remarkably significant（P 〈 0.01）.Conclusion The endoscopic morphology of LST has certain particularity,is closely associated with colorectal cancer,and is numerously located in the rectum.The canceration rate and malignant potential of each endoscopic type of LST are relatively high,which requires more attention and corresponding treatment measures.

关 键 词：大肠侧向发育型肿瘤 内镜 病理学 分型 

分 类 号：R730.2[医药卫生—肿瘤] R730.49[医药卫生—临床医学]