采用腺管开口分型和内镜黏膜切除术诊治大肠肿瘤

目的 探讨早期大肠癌及癌前病变的诊治新方法。方法 2000年11月-2001年8月结肠镜检查1250例采用内镜下黏膜染色技术。结合放大内镜，实体显微镜观察腺管开口分型（pit分型），并与病理诊断对照，pit分型采用工藤分型。内镜黏膜切除术50例次。结果 282例患者发现大肠隆起，扁平等不同病变共478个。共检出大肠黏膜内癌3例。黏膜下癌1例，进展期癌57例，其中Ⅱa,Ⅱb,Ⅱa Ⅱc病变44个，LST型病变16个，直径16-58mm，其中Ⅱ型1个，ⅢL6个，Ⅳ8个，Ⅴa型1个，2例黏膜内癌，1例Ⅱa Ⅱc病变，肿瘤已浸润到浅肌层，内镜下行内镜下黏膜切除术（EMR）或内镜下分片黏膜切除术（EPMR）治疗50例次，包括侧向发育肿瘤（LST）病变14个，Ⅱa病变22个，Ⅱb病变14个，结论 大肠腺管开口对于判断肿瘤性，非肿瘤性病变以及早期大肠癌具有重要意义，Ⅴ型腺管开口高度提示早期癌的可能，内镜下黏膜切除术适合于大肠平坦型病变的切除。为完全，有效的方法。

Pit pattern and endoscopic mucosal resection in diagnosis and treatment of colorectal tumors

OBJECTIVE: To explore the effective methods to diagnose and treat colorectal cancer in its early stage. METHODS: 1 205 patients were examined by colonoscopy and mucosa staining with indigocarmine. The pit patterns were observed with magnifying endoscope and stereomicroscope according to the Kudo classification. The pathological diagnoses of the lesions were compared with their pit patterns. Electrocoagulation resection was performed on the prominent lesions and endoscopic mucosal resection (EMR) or endoscopic partial mucosal resection (EPMR) was performed on the flat lesions. RESULTS: In the 282 patients 478 prominent and flat lesions were found. There were 16 cases of laterally spreading tumor (LST), including I case of pit pattern II, 6 of pit pattern IIIL, 8 of pit pattern IV, and 1 of pit pattern Va, with 2 cases of intramembrane cancer and 1 case of IIa + IIc lesions invading the superficial myometrium among them. EMR and EPMR were performed on 14 LST lesions, 22 IIa lesions, and 14 IIb lesions. CONCLUSION: The examination of pit pattern is very important in early diagnosis of colorectal cancer and differentiation tumorous from non-tumorous lesions. V type pit pattern is an indicator of colorectal cancer. EMR and EPMR are safe and effective for flat lesions.