大肠侧向发育型肿瘤(LST)早期癌变8例内镜下治疗及随访

目的 探讨大肠侧向发育型肿瘤(LST)早期癌变在内镜下治疗的新方法及疗效。方法 采用放大大肠镜与黏膜染色技术观察黏膜pit分型,发现LST早期癌变,并采用内镜下黏膜剥离切除术(EMR)对LST早期癌变进行治疗且随访疗效。结果 8例LST早期癌变主要分布在直肠、乙状结肠和降结肠,占75％;病变大于30mm以上者占75％;放大内镜下病变pit分型以Ⅳ型为主,占75％;病理形态以绒毛状腺瘤癌变为主,占62．5％,浸润深度以黏膜内癌为主,占75％(m sml占87．5％)。8例早期病变均进行EMR,一次性完全切除成功,其中EMR和内镜下分片黏膜剥离切除术(EPMR)各4例。平均随访20．7个月,随访期间均未发现肿瘤局部残留、复发及转移。结论大肠侧向发育型肿瘤早期癌变多为黏膜内癌,内镜下行EMR是一种有效的或可能治愈的方法。     

内镜下黏膜切除术治疗结直肠肿瘤

目的用内镜下黏膜切除术(EMR)治疗早期大肠癌及癌前病变,探讨病变大体分型和表面形态与病理组织学分型之间的关系。方法2002年12月-2004年12月共完成结直肠肿瘤EMR手术58例(其中男性49例,女性9例,平均年龄65．8岁),共计70个病变,对切除标本进行常规病理组织学观察。术后内镜随访1～23个月。结果70个病灶均为完全切除,除3例发生可控制出血外,未发生其他与手术相关的并发症。病理报告：3个病灶为早期癌,53个为腺瘤伴1～3级异型增生,其余14个均为炎性增生。随访期间所有病例均无复发。结论EMR可作为治疗黏膜层及黏膜下浅层早期大肠癌或癌前病变的方法。     

放大内镜及实体显微镜对结肠肿瘤性病变检查的意义

目的 探讨如何通过放大内镜和实体显微镜观察分析大肠息肉腺管开口类型,从而发现早期大肠癌及癌前病变。方法 2001年8月-2002年2月结肠镜检查139例大肠病变。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 pattem)并与病理诊断对照。结果 139例患者中发现大肠息肉124例,进展期癌9例,LST型病变5例。5例LST的直径为10-50mm,其中ⅢL型1个,Ⅳ型4个。本组采用放大内镜与病理、实体显微镜诊断的符合率高。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,如发现有V型腺管开口则高度提示早期癌的可能。     

放大肠镜下行大肠息肉染色及切除治疗的护理

目的：探讨放大肠镜下大肠息肉染色及切除治疗的护理体会。方法：使用靛胭脂对大肠息肉样病变部位进行染色,然后用放大电子肠镜观察记录腺管开口形态,进行活检及电切后观察组织学变化。结果：染色后放大肠镜观察共发现85枚息肉,镜下诊断与病理诊断符合率为87.1%。肠镜下对81个良性病变进行了同步微创治疗,并为决定其他4个病灶的治疗方案提供了重要依据。结论：放大内镜结合黏膜染色分析大肠息肉腺管开口形态,能有效鉴别大肠非瘤性息肉、腺瘤和癌,实时地选择性处理大肠息肉。正确细致的护理和医护之间的密切配合是不可缺少的环节。     

内镜黏膜切除术及剥离术治疗大肠早癌及癌前病变分析

目的探讨内镜黏膜切除术(EMR)及黏膜下剥离术(ESD)治疗大肠早癌及癌前病变的价值。方法对38例结肠较大隆起病变(直径≥1 cm)进行活检,病检提示为管状腺瘤伴中重度异型增生的,再行EMR或ESD术,分析其疗效及安全性。结果所有38例早癌及癌前病变均成功切除送检,完整切除率为97.37%(37/38);病理结果:中度异型增生17例,重度异型增生11例,癌变10例(其中1例结合术后病检结果追加了外科手术治疗);术中明显出血者EMR 0例,ESD 1例,明显出血率为0.26%(1/38);38例均未发生穿孔,术后1、6、12个月复查,无一例复发。结论 EMR及ESD术切除大肠早癌及癌前病变安全、有效。     

罕见大肠平坦型病变并锯齿状腺瘤2例报道

大肠侧向发育型肿瘤（laterally spreading tumor,LST)指起源于大肠黏膜的一类平坦隆起型病变,这类病变极少向肠壁深层垂直侵犯,而主要沿黏膜表面呈侧向浅表扩散。大肠的锯齿状腺瘤（serrated adenoma)指大肠的一类特殊病理形态的腺瘤,其成瘤上皮成分有明显增生,使腺管或绒毛呈锯齿状外观,类似于增生性息肉样改变,或腺瘤成分与增生性息肉成分同时存在。以上     

大肠息肉679例临床特征及内镜、病理学特点分析

 目的 研究大肠息肉患者的年龄,息肉的发生部位、大小、病理类型以及息肉癌变的相关规律.方法 对电子肠镜检查中检出的大肠息肉患者的临床表现、内镜特点及病理资料进行总结和分析.结果 在3 680例肠镜检查者中,发现大肠息肉679例,其中男468例,女211例,检出率18.45%; 好发年龄以30～69岁为主,占80.41%;炎性、增生性、腺瘤性、错构瘤性、幼年性息肉分别占33.87%、32.11%、31.37%、1.77%、0.59%;息肉部位分别为直肠34.18%、乙状结肠23.12% 、降结肠14.96%、横结肠12.13%、升结肠11.49%、盲肠4.11%.679例大肠息肉患者中有30例发生癌变,癌变率为4.42%.管状腺瘤、混合性腺瘤、绒毛状腺瘤癌变率分别为5.88%、4.21 %、23.08%.息肉直径≤1.0 cm,无癌变发生;1.1～1.9 cm息肉,癌变率4.24%;≥2.0 c m息肉,癌变率21.37%.结论 30～69岁大肠息肉发病率较高,年龄大于50 岁为危险因素,男性较女性更容易患大肠息肉;息肉好发部位为左半结肠;病理类型以炎性息肉、增生性息肉和腺瘤性息肉常见;左半结肠、直径≥2.0 cm息肉、绒毛状腺瘤容易癌变 ;发现大肠息肉应尽可能切除,并应建立良好的随访机制,内镜下切除大肠息肉可预防息肉癌变.     

侧方扩展型大肠肿瘤的X线特征

目的:探讨扩展型大肠肿瘤的X线与病理学特征。方法:分析了经组织病理学证实的46例54处病变的X线钡灌肠造影表现和内镜图像,将病变分为非结节扁平隆起、结节集簇性隆起和混合性结节集簇隆起3种类型,与病理组织学进行对照研究。结果:扩展型大肠肿瘤好发于直肠、盲肠和升结肠近段,组织病理学多为腺瘤或黏膜内癌,混合结节集簇隆起型病变癌变率高、浸润较深,且有进展期癌。结论:扩展型大肠肿瘤表面的形态改变,可以作为推测有无癌变与癌变浸润深度的指标。     

美蓝-靛胭脂双重染色对早期胃癌及不典型增生的诊断价值

目的研究内镜下美蓝-靛胭脂双重染色对早期胃癌及不典型增生的诊断价值。方法内镜下将104例胃黏膜异常表现患者分为两组,每组各52例。染色组内镜下先喷洒0.2%靛胭脂染色,发现可疑病灶后,再喷洒0.5%美蓝染色,然后在染色异常部位给予活检并送病理组织学检查;对照组不作染色,按肉眼判断,常规活检。结果染色组中检出有19例存在轻度到中度不典型增生,1例存在重度不典型增生,1例为重度不典型增生癌变,黏膜内癌2例,2例经手术及术后病理证实病灶仅限于黏膜层且无淋巴结转移,1例患者去向不明;对照组中分别检出6例轻度至中度不典型增生,早期胃癌0例,6例不典型增生复查时有1例因肉眼高度怀疑癌变而染色,着深蓝色后再次活检,病理报告少量腺体重度不典型增生伴癌变。两组检出率差异有统计学意义（P〈0.01）。结论内镜下美蓝-靛胭脂双重染色可显著提高胃不典型增生和早期胃癌的检出率。     

直肠类癌内镜治疗27例报告

目的探讨直肠类癌的超声内镜(EUS)诊断与内镜治疗效果。方法选择2005年6月-2009年12月结肠镜检查发现直肠黏膜隆起性病变,EUS结果高度怀疑直肠类癌且病变<1.0cm的患者进行内镜切除。术后明确病变切除是否完整,切除完整后于病变切除创面边缘取材4~6块同时送检。术后病理评价EUS诊断准确率,分析病变侵袭性状况,以及内镜完整切除率。随访观察每半年1次,复查肠镜及肝脏超声。结果共纳入直肠黏膜隆起性病变患者27例,均为采用EUS筛查高度怀疑类癌且具有内镜切除指征的患者。内镜切除均取得成功,病理证实类癌符合率92.6%(25/27),1例考虑为间质瘤,1例考虑为颗粒细胞瘤。25例类癌患者随访观察33.7±12.5个月,无复发和转移病例。结论 EUS在直肠黏膜隆起性病变诊断中具有较高准确性,在评价内镜切除指征方面具有不可替代的作用。内镜治疗1.0cm以下直肠类癌安全有效。     

重视平坦型大肠肿瘤的临床诊治

平坦型大肠肿瘤包括表浅型大肠肿瘤及凹陷型大肠肿瘤,与大肠癌发生有密切相关的特殊性。表浅型大肠肿瘤以大肠侧向发育型肿瘤(1aterally spreading tumor,LST)为代表;凹陷型大肠肿瘤以凹陷型早期大肠癌(Ⅱc型早期大肠癌)为代表。平坦型大肠肿瘤由于在临床上难以发现,在我国尚未被临床医师普遍认知,因此有关报道极少。近年来,南方医院在做肠镜检查中对平坦型大肠肿瘤的检出和诊疗上创造与积累了一些自己的经验,他们认为,提高大肠平坦型病变征象的识别和染色内镜的应用是发现大肠平坦型病变的关键,黏膜剥离术和分析黏膜剥离术是诊治大肠平坦型病变的最佳方法之一,而且已着手开展对平坦型大肠肿瘤发生发展的基础研究工作。     

Incidental colonic focal lesions detected by FDG PET/CT

OBJECTIVE: The aim of this study was to assess the performance of FDG PET/CT for the detection of colonic lesions, especially advanced neoplasms (villous or >10-mm adenomas, carcinomas). Because of 18F FDG accumulation in adenomatous polyps, PET using FDG can detect early premalignant colorectal lesions. MATERIALS AND METHODS: FDG PET/CT studies performed for a 1-year period in 1,716 consecutive patients with various malignant diseases, except colorectal cancer, were retrospectively reviewed. PET images obtained 1 hr after FDG injection and non-contrast CT images used for attenuation correction were fused for analysis. Of 45 patients showing intense focal colonic FDG uptake, 20 patients (with 21 foci) underwent a colonoscopic investigation, and, when necessary, polyp resection. The intensity of FDG uptake was quantified using the standardized uptake value (SUV(max)). RESULTS: The FDG colonic foci were associated with 18 colonoscopic abnormalities in 15 patients, with no colonic abnormality detected in five patients (false-positive [FP] results). Histopathologic findings revealed advanced neoplasms in 13 patients (13 villous adenomas and three carcinomas) and two cases of hyperplastic polyps. A difference in the mean SUV(max) was found between FP and true-positive colonic FDG foci but was not statistically significant (p = 0.14). CONCLUSION: Presence of a focal colonic FDG uptake incidental finding on a PET/CT scan justifies a colonoscopy to detect (pre-)malignant lesions. The fusion of PET and CT images allows an accurate localization of the lesions. PET/CT is a useful tool to differentiate pathologic from physiologic FDG uptake.     

Early gastric cancer and early colon cancer detected simultaneously by PET cancer screening incidentally

We report a case of early gastric cancer and early colon cancer detected by positron emission tomography (PET) cancer screening. A 64-year-old male patient with an unremarkable past history except for hypertension and cerebrovascular disease underwent 18F-FDG PET for cancer screening. Images revealed increased uptake in the gastric antrum and sigmoid colon. Both areas appeared suspicious for neoplasm on subsequent fluoroscopy and endoscopy, and biopsies were positive for neoplasia at both sites. The gastric lesion was treated by distal gastrectomy and D2 lymphadenectomy and the colon cancer by endoscopic mucosal resection (EMR). Both surgical specimens were positive for cancer.     

早期结肠癌低张气钡双对比造影检查与纤维结肠镜对比分析

目的:对于早期结肠癌的检查,通过低张气钡双对比造影(DCBE)图像与纤维结肠镜检查图像对比观察,分析气钡双对比结肠造影在检出早期结肠癌中的价值。方法:20例经病理证实早期结肠癌病例,采用低张气钡双对比造影方法,实时点片。常规纤维结肠镜检查。结果:Ⅰ型11例,Ⅱa型6例,混合型1例,LST型2例,对比观察造影像及内镜像表现。结论:正确运用气钡双对比造影检查,对早期结肠癌的显示有较大价值。     

18F-FDG PET detection of colonic adenomas.

The adenomatous polyp of the colon is clinically important as a precursor of colonic cancer. The aim of this preliminary study was to evaluate the potential usefulness of (18)F-FDG PET for detecting adenomatous polyps of the colon. METHODS: We performed a retrospective study of 110 subjects who underwent both PET study and total colonoscopy. On nonattenuation-corrected PET images, focal distinct FDG accumulation along the large intestine was considered a positive finding, and the PET results were compared with colonoscopic findings. Histology and adenoma size were determined by polypectomy. RESULTS: Fifty-nine adenomatous polyps, 5-30 mm in size, were found in 30 subjects by total colonoscopy. PET findings were positive for 14 of the 59 adenomas (24%). The positivity rate for PET images rose with the increase in size of the adenomas; it was 90% in adenomas (9/10) that were > or =13 mm. The overall false-positive rate was 5.5% (6/110 subjects). CONCLUSION: Increased glucose metabolism is observed in colonic adenomas, and detectability with PET increases with the increase in adenoma size. Adenomas are premalignant lesions, and it is important to realize that colonic adenomas may be found incidentally during an FDG PET study.     

Atypical appearances of benign hyperplastic gastric polyps.

The vast majority of epithelial polyps of the stomach can be divided into two groups: (1) hyperplastic or regenerative polyps, and (2) adenomas. Of the two, hyperplastic polyps are much more common; they are nonneoplastic lesions which are typically asymptomatic, small, smooth-surfaced, and often multiple. Malignant transformation virtually never occurs in this group of polyps. Adenomas are true neoplasms; they are relatively large, have an irregular surface, and show a distinct tendency to undergo malignant transformation. In this paper the radiologic appearances of hyperplastic gastric polyps, with special reference to atypical findings, are discussed and illustrated. It is shown that simple hyperplastic polyps may present any or all of the radiologic criteria suggestive of gastric adenomas or even frank malignancy. Thus, while radiology plays a vital role in the initial detection and followup of gastric polyps, optimum clinical management of the patient is best based on knowledge of the histologic structure of the lesion obtained by endoscopy and biopsy.     

16层螺旋CT结肠三维成像与仿真内镜的临床应用研究

目的 探讨16层螺旋CT三维成像与仿真内镜在结肠肿瘤诊断中的应用价值。资料与方法 应用Lightspeed 16CT对26例纤维结肠镜活检证实的结肠癌(19例)和结肠息肉(7例)进行容积扫描．在AW4-2工作站进行三维成像和仿真内镜观察．并与纤维结肠镜结果相比较。结果 25例三维成像效果良好．仿真内镜与纤维结肠镜显示基本一致,1例因肠道准备不彻底,成像效果欠佳,但不影响诊断;CT仿真结肠镜(CTVC)结合2D多平面重建(MPR)和透明显示(Raysum)图像,可以提供更多信息,有助于病变的准确定位、定性。结论16层螺旋CT仿真内镜结合三维成像能达到与纤维结肠镜同样的敏感性和特异性,加上MPR、RavSun图像技术可以提供比纤维结肠镜更丰富的信息。     

Structuring and use in clinical research of a software for the diagnosis and features of polypoid lesions of the colorectum

Double contrast enema and endoscopy are very important in the diagnosis of adenomas and early cancer of the colon and rectum. These exams can not only detect the presence, but also suggest the histologic diagnosis, of polypoid lesions of the colon. An Olivetti M24 Personal Computer was used to create a software to study the results obtained by double contrast enema, and to compare them with endoscopy and pathology. The data base is formed by 7 files: one anagraphic, 3 collecting the characteristics of the diagnosis--namely the radiologic, the endoscopic and the pathologic one-- and 3 multiple files featuring each lesion, as defined by the three diagnostic techniques. The software allows to evaluate the different lesions that can be detected by the three techniques in the same patient and to compare the diagnosis of presence to the morphologic features of each lesion. False negatives and false positives of each technique are easily recognized. It is also possible to characterize the single morphologic feature leading the radiologist and/or the endoscopist to express an opinion about the histologic diagnosis of each lesion and to compare them with pathological features. The first experience in clinical use of the software, in the analysis of the characters of 336 lesions in 218 patients, is described.