大肠侧向发育型肿瘤内镜下的诊断及治疗

目的探讨大肠侧向发育型肿瘤（Laterally Spreading Tumor，LST）内镜下的诊断与治疗价值，以及LST的临床意义。方法使用Olympus CF—Q260AI和CF—H260AZI电子肠镜，对2008年6月至2009年6月在我院作肠镜检查的患者（共3962例），在发现病变后采用0．4％靛胭脂行病变粘膜染色，放大内镜观察，确定病变腺管开口分型，择期进行粘膜剥离切除术（EMR）或分片粘膜切除术（EPMR）治疗。结果检出LST患者26例，检出率0.66％，病变数31个，其中直肠11个，乙状结肠5个，降结肠2个，横结肠4个，升结肠9个；颗粒均一型11个，结节混合型18个，扁平隆起型2个；表现为ⅢL型腺管开口7个（22．6％），Ⅳ型腺管开口19个（61．3％），兼有ⅢL型及Ⅳ型腺管开口5个（16．1％）。全部病例行EMR或EPMR治疗，未发生任何出血或穿孔等并发症。3个（9．7％）病理提示局部癌变。结论提高LST的临床检出率须应用粘膜染色技术和放大内镜。LST的腺管开口大多数表现为ⅢL型或Ⅳ型，而ⅢL型腺管开口多为管状腺瘤，Ⅳ型腺管开口多为绒毛状腺瘤，LST与大肠癌关系密切，对其应足够重视。治疗上采用内镜下粘膜剥离术是安全可行的。

Diagnosis and Treatment of Laterally Spreading Tumor through Endoscopy

Objective： To evalulate the clinical meaning of the Laterally Spreading Tumor （LST） of large intestine and diagnosis and treatment of it with endoscopy. Methods： 2226 patients were examined in our hospital by magnifying chromoscopy which made in Olympus Japan during the pcriod from June, 2008 to June, 2009.Once the lesions were detected, sprayed with Indigo Carmine （0.4%）, then observed the shape of the Pit pattern by magnifying chromoscopy. Immediate or elective endoscopic mucosa resection or partitioned mucosa resection was perfomed. Results： 26 patients and 31 lesions of LST were found .The lesions site of LST is 11 lesions site on rectum, 5 lesion site on sigmoid colon, 2 lesion site on descending colon, 4 lesions site on transverse colon, 9 lesion site on ascending colon.9 lesions were classified into granular homogeneous type, 18 lesions into nodular mixed type, 2 lesions were flat elevated type. The pit pattern on magnifying chromoscopy suggested 7 lesions of type Ⅲ L pit and 19 lesions of type Ⅳ pit, 5 lesion of type ⅢL ＋ Ⅳ pit.All of the 31 lesions are resected by endoscopic mucosa resection or partitioned mucosa resetion. No complications occurred for the patients during treatment of EMR or EPMR such as bleeding or perforation. The pathological diagnoses of 3 lesions are early malignant degeneration. Conclusion： Mucosa staning and magnifying chromoscopy is useful to detect LST. Most pit patterns of LST are Ⅳ or ⅢL, and LST with Ⅳ pit patterns are mainly villous adenoma, ⅢL tubular adenoma. LST has a close relationship with colorectal cancer, we must pay more attention to it. EMR or EPMR may consider as good treatment of LST.