结直肠侧向发育型肿瘤266例的临床和病理特征分析  

Analysis of clinical and pathological characteristics of 266 cases of colorectal laterally spreading tumor

作　　者：郝钰洁 樊莹莹 金雨鑫 严艳[1] Hao Yujie;Fan Yingying;Jin Yuxin;Yan Yan(Department of Gastroenterology,the Second Affiliated Hospital of Dalian Medical University,Dalian 116023,China)

机构地区：[1]大连医科大学附属第二医院消化一科,大连116023

出　　处：《中华消化杂志》2022年第6期389-394,共6页Chinese Journal of Digestion

摘　　要：目的分析结直肠侧向发育型肿瘤(CLST)的临床和病理特征,为CLST的临床诊治提供参考依据。方法回顾性收集2016年1月1日至2021年6月30日在大连医科大学附属第二医院行内镜下治疗的CLST患者的临床病历资料,从病灶部位(右半结肠、左半结肠、直肠)、病灶分型(颗粒均一型、结节混合型、扁平隆起型和假凹陷型)方面分析CLST的临床和病理特征。统计学方法采用单因素方差分析、Pearson卡方检验和Fisher确切概率法。结果共纳入266例CLST患者,296个CLST病灶。病灶最大径以10~29 mm最多见,占85.1%(252/296);病灶分型以颗粒型为主,占81.4%(241/296);病理形态则以腺瘤为主,占79.7%(236/296);组织学类型以低级别上皮内瘤变(LGIN)最多见,占81.1%(240/296)。直肠CLST的病灶最大径大于右半结肠、左半结肠[分别为(24.20±16.97)、(18.38±8.24)、(18.59±7.95)mm],差异有统计学意义(F=6.62,P<0.001)。直肠CLST病灶中颗粒均一型的检出率低于右半结肠、左半结肠[分别为22.0%(11/50)、53.5%(69/129)、58.9%(69/117)],而直肠CLST病灶中结节混合型的检出率高于右半结肠、左半结肠[分别为50.0%(25/50)、29.4%(38/129)、24.8%(29/117)],差异均有统计学意义(χ^(2)=20.06、10.67,均P<0.01)。右半结肠CLST的腺瘤发生率低于左半结肠、直肠[分别为68.2%(88/129)、87.2%(102/117)、92.0%(46/50)],而右半结肠CLST的锯齿状病变发生率高于左半结肠、直肠[分别为30.2%(39/129)、12.8%(15/117)、4.0%(2/50)],差异均有统计学意义(χ^(2)=19.25、20.85,均P<0.001);左半结肠CLST多采用内镜黏膜下剥离术治疗(94.9%,111/117),直肠CLST多采用内镜黏膜切除术治疗(20.0%,10/50),差异有统计学意义(χ^(2)=8.77,P=0.012)。假凹陷型CLST的病灶最大径大于颗粒均一型、结节混合型、扁平隆起型[分别为(24.18±14.07)、(15.96±5.70)、(23.49±13.80)、(21.21±8.02)mm],差异有统计学意义(F=13.40,P<0.001);扁平隆起型CLST的腺瘤发生率高Objective To analyze the clinical and pathological characteristics of colorectal laterally spreading tumor(CLST)and provide reference for clinical diagnosis and treatment of CLST.Methods From January 1,2016 to June 30,2021,the clinical data of patients with CLST who underwent endoscopic resection at the Second Affiliated Hospital of Dalian Medical University were retrospectively collected.The clinical and pathological characteristics of CLST were analyzed in terms of lesion location(right colon,left colon,rectum)and morphological type(granular-homogeneous type,granular-mixed type,flat-elevated type,and pseudo-depressed type).One-way analysis of variance,Pearson′s chi-square test and Fisher′s exact test were used for statistical analysis.Results A total of 266 patients with CLST and 296 CLST lesions were included.The most common maximum diameters of the lesions were 10 to 29 mm,accounting for 85.1%(252/296).The main morphological type was granular type,accounting for 81.4%(241/296),and the main pathological type was adenoma,accounting for 79.7%(236/296),and the most common histological type was low-grade intraepithelial neoplasia(LGIN),accounting for 81.1%(240/296).The maximum diameter of CLST lesion of rectum was larger than that of the right colon and the left colon((24.20±16.97),(18.38±8.24)and(18.59±7.95)mm,respectively),and the difference was statistically significant(F=6.62,P<0.001).The detection rate of granular-homogeneous type CLST in rectum was lower than that in the right colon and the left colon(22.0%,11/50,53.5%,69/129 and 58.9%,69/117,respectively),while the detection rate of granular-mixed type CLST in rectum was higher than that in the right colon and the left colon(50.0%,25/50;29.4%,38/129 and 24.8%,29/117,respectively),and the differences were statistically significant(χ^(2)=20.06 and 10.67,both P<0.01).The incidence of adenoma in CLST in the right colon was lower than that in the left colon and rectum(68.2%,88/129;87.2%,102/117 and 92.0%,46/50,respectively),while the incidence of serrate

关 键 词：结直肠侧向发育型肿瘤 临床特征 病理特征 内镜治疗 

分 类 号：R735.34[医药卫生—肿瘤]