结直肠高级别上皮内瘤变诊治进展  

Advances in the diagnosis and treatment of high-grade intraepithelial neoplasia of the colorectum

作　　者：杨洋 费秉元[1] 王琪 谢忠士[1] 沈可欣[1] YANG Yang;FEI Bing-yuan;WANG Qi(Department of Gastrointestinal Colorectal and Anal Surgery,China-Japan Union Hospital of Jilin University,Changchun 130031,China)

机构地区：[1]吉林大学中日联谊医院胃肠结直肠肛门外科,吉林长春130031

出　　处：《中国实用外科杂志》2023年第7期837-840,共4页Chinese Journal of Practical Surgery

基　　金：吉林省自然科学基金项目(No.20200201574JC)。

摘　　要：WHO推荐应用“上皮内瘤变”这一新定义代替“异型增生”和“原位癌”,强调上皮内瘤变属于癌前病变,应区别于恶性肿瘤的治疗方法。概念的细化,对临床诊断与病理诊断的标准提出了更高的要求,而对治疗方式方法的选择,也提出了更精准的要求。对于结直肠高级别上皮内瘤变,当病变无明显的黏膜下浸润、淋巴结转移、脉管浸润和内镜下治疗禁忌证时,应首选内镜下治疗。存在上述任一风险时,建议追加手术治疗,达到根治性切除。建议采用多学科综合治疗协作组模式进行综合评估,个体化分析,为病人提供最佳的诊疗方式。WHO recommended the new definition of"intraepithelial neoplasia"instead of"heterogeneous hyperplasia"and"carcinoma in situ",emphasizing that intraepithelial neoplasia is a precancerous lesion and should be distinguished from the new definition of"intraepithelial neoplasia"replaces"heterogeneous proliferation"and"carcinoma in situ".The refinement of the concept puts forward higher requirements for the standards of clinical diagnosis and pathological diagnosis,and also puts forward more accurate requirements for the selection of treatment methods.For patients with high-grade intraepithelial neoplasia of the colorectum,endoscopic therapy should be preferred when the lesions have no obvious submucosal invasion,lymph node metastasis,vascular invasion,and contraindications of endoscopic therapy.In the presence of any of these risks,additional surgical treatment is recommended to achieve radical resection.Recommend adopting multidisciplinary team(MDT)model for comprehensive evaluation and individualized analysis,so as to provide the best diagnosis and treatment method for patients.

关 键 词：上皮内瘤变 结直肠肿瘤 手术治疗 内镜切除 

分 类 号：R6[医药卫生—外科学]