染色内镜和放大内镜技术是提高早期大肠癌诊治水平的重要手段

应用常规内镜技术难以发现大肠平坦型病变和凹陷型病变。近年来染色内镜和放大内镜技术已经发展成熟,在国外已获广泛应用,可以发现大肠微小病变和早期大肠癌。应用腺管开口分型方法可以预测肿瘤病变的组织学类型及肿瘤的浸润深度,据此可确定行内镜下粘膜剥离术或分片粘膜剥离术将肿瘤切除,抑或行外科手术治疗。在当前我国的胃肠内镜医疗界,应广泛开展染色内镜和放大内镜的临床应用,以早期发现大肠病变,提高我国大肠癌的内镜诊治水平。     

窄带成像技术联合染色放大内镜诊断早期大肠癌的价值观察

目的探讨窄带成像技术(NBI)联合染色放大内镜诊断早期大肠癌的价值观察。方法选取2018年4月～2019年9月于我院内镜中心行内镜检查发现有结肠肿瘤样病变的患者67例入组,对入组患者的86枚肿瘤样病变行NBI+染色放大内镜观察腺管及血管分布情况,记录诊断结果;同时行活组织病理检查,比较NBI+染色放大内镜检查结果与病理结果,分析两组数据的一致性。结果 NBI联合染色放大内镜诊断早期大肠癌的灵敏度、特异度、检出正确率、阳性预测值和阴性预测值分别为94.44%、90.32%、92.54%、91.89%和93.33%,两种诊断结果Kappa值为0.850。结论采用NBI联合染色放大内镜诊断结肠肿瘤样病变与活组织学病理检查诊断结果具有一致性,对早期大肠癌病变的诊断具有临床应用价值。     

放大内镜及黏膜染色在大肠息肉诊断中的应用

目的 探讨放大内镜及肠镜下黏膜染色在大肠息肉诊断中的应用价值。 方法 对31例112枚息肉行常规大肠镜检查,确定息肉的部位、数目及形态特点后,镜下喷洒0．4％靛胭脂进行黏膜染色,放大内镜观察其腺管开口的类型。 结果 25枚炎性息肉中,4枚腺管开口为Ⅰ型,21枚为Ⅱ型;37枚增生性息肉中,18枚腺管开口为Ⅰ型,18枚腺管开口为Ⅱ型,1枚为Ⅳ型;33枚管状腺瘤中,30枚腺管开口为ⅢL型,1枚为Ⅱ型伴局部Ⅲs型,1枚为Ⅱ型伴局部ⅢL型,1枚为Ⅳ型;17枚绒毛状腺瘤或管状绒毛腺瘤中,14枚腺管开口为Ⅳ型,1枚腺管开口为ⅢL型,1枚为Ⅳ型伴局部Ⅵ型,1枚为Ⅳ型伴局部VN型。 结论应用放大内镜和黏膜染色技术,有助于根据腺管开口类型判断其可能的病理组织学类型,对治疗方法的选择及疗效和预后的判定有指导意义。     

染色放大内镜观察大肠息肉表面腺管开口的临床价值

目的探讨染色放大内镜下观察大肠黏膜腺管开口分型对诊治大肠息肉性病变的临床价值。方法在行常规肠镜检查发现的73例息肉样病变中,给予0.2%的靛胭脂染色,结合放大技术观察息肉表面黏膜腺管开口形态,在工藤分型法基础上增加了混合型,Ⅰ、Ⅱ型为非瘤性息肉,ⅢS、ⅢL、Ⅳ及混合型为腺瘤性息肉,V型为癌变,比较息肉腺管开口形态与组织病理之间的关系。结果在检出的73枚大肠息肉病变中,病理诊断非肿瘤性息肉共22枚,内镜下非肿瘤性腺管形态(Ⅰ～Ⅱ型)占86.4%(19/22),肿瘤性腺管形态(ⅢL及混合型)占13.6%(3/22);病理诊断肿瘤性息肉共39枚,内镜下非肿瘤性腺管形态(Ⅰ型)占2.6%(1/39),肿瘤性腺管形态(ⅢL、ⅢS、Ⅳ、混合型)占97.4%(38/39);病理诊断腺癌12枚,都无一例外的呈Ⅴ开口。诊断非肿瘤性(Ⅰ～Ⅱ型)和肿瘤性(Ⅲ～Ⅴ型)息肉病变的病理符合率达94.5%(69/73);诊断非肿瘤性息肉诊敏感性达86.4%,特异性达95.0%;诊断肿瘤性息肉的敏感性达98.0%,特异性达94.3%。结论大肠腺管开口对判断大肠息肉病变性质有较高的病理符合率,并能有效的鉴别肿瘤性、非肿瘤性病变,有助于在检查过程中及时的选择处理大肠息肉。     

放大内镜与实体显微镜对早期大肠癌的诊断价值

放大内镜与实体显微镜检查鉴别病变的范围和分离出病变标本在早期癌症的病理诊断中是非常重要的 ,特别是对凹陷型微小癌的意义尤为重要。1　肿瘤与非肿瘤性病变腺管开口的识别1.1　组织学分析腺管开口类型　切除的标本用福尔马林固定、脱浆、用卡拉奇苏木精或甲苯基紫染色 ,然后用水浸泡后在立体超微显微镜下观察。染色方法分为核染色和胞浆染色 ,前者通常包括应用卡拉奇苏木精或甲苯基紫 ,后者应用亚甲基蓝 ,具体应用哪种方法取决于目的。与H -E染色相比 ,实体显微镜标本的染色是用细胞核染色方法 ,通过放大内镜检查获得腺管开口类型 ,用…     

50例结肠息肉腺管开口的放大内镜观察分析

目的:探讨放大内镜观察腺管开口分型对大肠息肉性病变的诊断价值。方法:肠镜检查中发现息肉性病变后,病灶部位喷洒0.4%靛胭脂,采用放大内镜观察病灶粘膜腺管开口形态,按Kudo分型作病灶性质判断,并与切除或活检组织病理学检查比较。结果:检出大肠息肉性病变50个,非肿瘤性息肉19个,占38%,其中增生性息肉3个(6%),炎症性息肉16个(32%);腺瘤性息肉28个,占56%;进展期大肠癌3例(6%)。非肿瘤性息肉腺管开口均为Ⅰ、Ⅱ型腺管开口;腺瘤型息肉腺管开口为ⅢL、Ⅲs、Ⅳ型分别占22%、12%、12%,3例进展期癌均表现为粘膜腺管开口破坏无结构,为ⅤN型。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结肠癌具有重要意义,V型腺管开口高度提示癌的可能,对指导内镜治疗或手术切除具有重要意义。     

临床评估黏膜染色提高早期大肠癌的诊断率及内镜下治疗价值

目的探讨和分析黏膜染色对早期大肠癌的诊断和内镜下治疗的价值。方法对我院收治的250例小病变患者采用0.4靛胭脂进行黏膜染色,同时对腺管开口和分型进行观察,对早期大肠癌采用直接切除或者采用内镜下黏膜切除手术治疗。结果腺管开口分型：I型：146例（活检病理正常黏膜96例、炎性病变50例）;Ⅱ型：20例（增生性病变14例、炎性病变4例、管状腺瘤2例）;Ⅲs型：6例（腺癌4例、腺瘤2例）;ⅢL型：26例（腺瘤样息肉20例、早期肠癌6例）;Ⅳ型：32例（绒毛状腺瘤20例、腺瘤8例、腺癌4例）;V型：20例（腺癌12例、早期肠癌8例）。对早期肠癌和有蒂以及亚蒂的患者直接采用高频电进行切除治疗;8例平坦和凹陷病变患者,经过EMR后,病理证实为早期癌。结论临床上,采用靛胭脂进行黏膜染色和腺管开口分型,能够有效地提高对早期大肠癌的诊断率,同时采用内镜下进行治疗,减轻患者的痛苦。     

放大内镜对胃黏膜平坦型病变的诊治价值

[目的]探讨放大内镜下胃黏膜平坦型病变的胃小凹形态及其临床病理意义.[方法]应用Olympus GIFQ240Z内镜对46例胃黏膜平坦型病变患者进行观察,局部喷洒4 g/L靛胭脂染色后利用其放大功能观察病变周围胃小凹形态改变,在观察部位取病理组织学检查,研究两者相互关系.[结果]46例病变中平坦隆起型病变(Ⅱa)33例,表面平坦型病变(Ⅱb)12例,隆起凹陷型病变(Ⅱa Ⅱc型)1例;小凹开口呈A型10例,B型8例,C型17例,D型6例,E型3例,2例病变其表面小凹模糊不清甚至消失.[结论]放大内镜对诊断平坦型病变有重要价值,病变周边小凹形态改变与病灶的良恶性存在密切关系.     

内镜黏膜切除术治疗平坦型早期大肠癌

目的　探讨内镜黏膜切除术 (EMR)治疗平坦型早期大肠癌的价值。方法　应用黏膜染色技术在放大内镜下对 6例大肠早期癌进行EMR治疗。结果　所有病例均一次完成。病变大小 :最大为 62mm× 82mm ,最小为 10mm× 10mm。病理诊断为大肠侧向发育型肿瘤并黏膜内癌 5例 ,凹陷型早期癌 (denovo癌 ) 1例。腺管开口类型 :ⅤA 型 4例 ,Ⅳ型 1例 ,Ⅲs型 1例 ,所有患者未出现出血、穿孔等并发症。结论　EMR治疗平坦型早期大肠癌安全有效     

结直肠癌早期检测的基因标志物

研究表明,肿瘤的发生和发展与癌基因和抑癌基因有着密不可分的关系.随着分子生物学理论和技术的发展,对癌基因和抑癌基因的检测已成为肿瘤临床预警和诊断的重要途径.自Fearon和Vogelstein 1990年提出结直肠癌发生的分子模型以来,结直肠癌发病的分子机制不断被阐明,通过对与结直肠癌相关的基因改变的检测可以为结直肠癌早期预警提供帮助.尤其是对具有家族病史的人进行相关基因改变的检测,检出率已经达到相当高的水平.本文对近年来被认为与结直肠癌相关的基因作一综述.     

Waiting times for colonoscopy and colorectal cancer diagnosis

OBJECTIVE: To evaluate whether prolonged waiting times for colonoscopy in public hospitals could result in delayed diagnosis of colorectal carcinoma. DESIGN, SETTING AND PATIENTS: Analysis of all outpatient colonoscopies performed at a Western Australian tertiary teaching hospital, 1 November 2003 - 31 October 2005. Colonoscopy data, corresponding pathological findings, category of urgency at referral for colonoscopy, and waiting time for colonoscopy were obtained. Patients were coded as having cancer if it was diagnosed by colonoscopy or if colonoscopy identified a lesion subsequently diagnosed as cancer. MAIN OUTCOME MEASURES: Colorectal carcinoma detected by outpatient colonoscopy and length of waiting time to colonoscopy. RESULTS: 1632 outpatient colonoscopies were recorded. Category I patients received a colonoscopy within the recommended 30 days from referral. Median waiting times for Category II and Category III patients exceeded recommendations (observed, 113 days and 258 days; recommended, within 90 days and 180 days, respectively), although the number of cancers detected was low (2.4% and 0.6% of referrals, respectively in each category). Early- and late-stage cancers had similar median waiting times from referral to diagnosis. Age over 65 years and the blood-loss indications - a positive faecal occult blood test or iron deficiency/anaemia - were predictors of an increased risk of carcinoma at colonoscopy. CONCLUSIONS: Waiting time for colonoscopy was not associated with an increase in the proportion of late-stage cancers diagnosed. Age over 65 years and evidence of blood loss increased the likelihood of a cancer diagnosis.     

内镜分光比色技术对早期胃癌诊断价值的研究

目的探讨内镜智能分光比色技术（FICE）在早期胃癌诊断中的价值。方法 525例常规胃镜检查发现有胃黏膜病变的病人纳入该研究。采用FICE对病变进行胃小凹及黏膜微血管形态观察,并与病理组织学诊断相比较,分析胃小凹及黏膜微血管与病理组织学关系,明确早期胃癌FICE下胃小凹及微血管形态特点。结果胃癌组胃小凹呈E型、F型,且E、F型胃小凹发生率差异有显著性（P〈0.01）;Ⅲ型、Ⅳ型血管改变,早期胃癌组与其他组比较差异有显著性（P〈0.01）;Ⅲ型血管改变,黏膜层癌与黏膜下层癌比较差异无显著性（P〉0.05）;Ⅳ型血管改变黏膜层癌与黏膜下层癌比较差异有显著性（P〈0.01）。结论胃小凹呈E、F型,特别是F型改变及Ⅲ、Ⅳ型胃黏膜微血管改变是早期胃癌FICE下特征性改变。应用FICE对胃黏膜病变处胃小凹及微血管观察,利于指导靶向活检,有助于提高早期胃癌检出率,有良好的临床实用价值。     

肠镜联合CT检查在大肠癌术前评估中的意义

目的 探讨肠镜及CT检查对大肠癌术前评估的准确性。方法 对205例大肠癌患者进行术前肠镜、CT检查，并与手术结果比较。结果 肠镜在大肠癌的确诊、定位与术中所见及术后诊断完全相符。肠镜的Borrmann分型与术中所见的肿瘤形态基本一致；CT检查肿瘤对浆膜及周围浸润的准确率为94.5%，主淋巴结的CT阳性率为68.4%，对远处转移CT检查的阳性率为90.5%，CT未发现中间淋巴结及边缘淋巴结转移。结论 肠镜和CT检查均可在术前准确评估大肠癌肿瘤的大小、形态、部位及周围组织浸润等，对主淋巴结转移也可作一定的评估。     

Xeromammography in early detection of breast cancer.

Sixty-four carcinomas were detected in 1,315 women examined by xeromammography in 1973. Seventeen carcinomas were occult and 14 were detected in women referred for clinically benign lesions. The remaining 33 carcinomas were diagnosed on the basis of both clinical and roentgenographic examination. There were three false-negatives. Two of these lesions were obscured by very dense fibrocystic disease. The third lesion was called benign due to an error in interpretation. There were eight false-positives; four of these demonstrated intraductal hyperplasia and asymmetry, which may be a precursor to frank malignant change. Xeromammography is suggested as a highly accurate means of detecting occult mammary carcinomas and clarifying the nature of clinically suspected lesions.     

The yield for colorectal cancer and adenoma by indication at colonoscopy

Colonoscopy is an integral part of the clinician armamentarium in the diagnosis of colorectal cancer and its precursor, the adenoma. Polypoid lesions when identified can be excised at colonoscopy and in turn reduce the risk of colorectal cancer. We prospectively evaluated the yield of colorectal cancer and adenomatous polyps by indication for colonoscopy over a one-year period. A total of 375 colonoscopies were carried out. The more common indications of colonoscopy were rectal bleeding, abdominal pain, surveillance of colorectal cancer and altered bowel habit. The highest yield for cancer was for rectal bleeding with 12.5% while surveillance of patients with a history of polyps yielded the highest percentage of new polyps. We conclude that rectal bleeding as an indication for colonoscopy yielded the highest number of cancers.     

实体显微镜下靶向取材对提高早期大肠癌检出率的研究

目的 建立一套适合内镜下黏膜剥离切除标本的临床病理取材方法,以提高早期大肠癌的检出率。方法 采用2005年8至12月南方医院常规结肠镜检查行内镜下黏膜剥离切除的大肠肿瘤性病变标本,对病变超过10mm以上可疑癌变的病例,采用黏膜染色,结合实体显微镜进行观察,根据腺管开口类型判断可疑癌变部位进行靶向取材病理检查,并与常规随机取材的标本进行对照,观察对大肠癌变检出率的影响,同时,将该期大肠早期癌检出情况与2004年随机取材的检出率进行对照。结果 采用黏膜染色结合实体显微镜进行靶向取材,在40例可疑癌变病例中,确诊早期癌变（包括重度不典型增生）16例,这16例标本随机取材送检后,除1例病理诊断为重度不典型增生外,其余15例均为轻度或中度不典型增生。2004年同期进行非靶向取材,在54例可疑癌变的大肠肿瘤中仅检出4例早期癌变（包括重度不典型增生）,检出率为7．4％。结论 内镜下黏膜剥离切除标本采用黏膜染色实体显微镜进行靶向定位活检,可提高大肠早期癌变的检出率。     

The influence of colonoscopy on the operative management of colorectal cancer

Total colonoscopy was used in the evaluation of 85 patients with colorectal cancer, either preoperatively or within six months of surgery. Synchronous lesions (six carcinomas, 22 adenomatous polyps, one villous adenoma and nine cases of severe diverticular disease) were detected in 38 (44.7%) patients. The planned surgical procedure was altered in 10 patients (11.8%)--a more extensive resection being performed in each case. In particular, five of the six cases of synchronous cancers were located in different surgical segments. Colonoscopy is a necessary prerequisite in the evaluation of patients with colorectal cancer.