大肠侧向发育型肿瘤内镜下的诊断与治疗

目的探讨大肠侧向发育型肿瘤（LST）临床病理特征及内镜下黏膜切除术的有效性、安全性。方法经普通内镜检查发现LST 119例,染色后观察病灶大小及部位并进行形态分型,再结合放大内镜确定腺管开口类型。有治疗适应证者行内镜下黏膜切除术,切除病灶黏膜送病理检查。结果 28个月中共发现119例LST 124个病变。内镜下分型：颗粒均一型44个,结节混合型48个,平坦隆起型23个,假凹陷型9个。病变直径：10～20 mm 65个,21～30 mm 23个,31 mm以上36个,最大病变110 mm×100 mm。病变部位：直肠50个,乙状结肠25个,降结肠11个,横结肠10个,升结肠＋盲肠28个。黏膜腺管开口类型：Ⅲ型30个,其中17个为管状绒毛状腺瘤,12个为管状腺瘤;Ⅳ型56个,其中30个为绒毛状腺瘤,4个为黏膜内癌;Ⅴ型5个,其中2个为黏膜内癌,2个累及黏膜下层下1/3以下;Ⅱ型7个,其中5个为炎性增生性息肉,2个为锯齿状腺瘤（腺瘤性增生性息肉）：其余为ⅢL＋V型,其中23个为管状绒毛状腺瘤。符合适应证95例98个病变择期进行内镜下黏膜切除治疗,发生出血11例,均在操作过程中,无肠穿孔发生。结论大肠LST内镜形态具有一定特殊性,内镜下黏膜切除术是治疗在大肠的有效而安全的方法,可达到根治目的 。

Endoscopic Diagnosis and Treatment of Colorectal Laterally Spreading Tumors

Objective To investigate the clinicopathologic features of colorectal laterally spreading tumors and the efficacy and safety of endoscopic mucosal resection（EMR）.Methods Through rontine endoscopy 119 cases of laterally spreading tumor（LST） were found.The size,location of the lesions and the morpological type were observed after staining.Combined with magnifying endoscopy,the pit type was determented.The lesions with indications underwent endoscopic mucosal resection,mucosal resections of the lesions were sent for pathological examination.Results There were 119 patients with LST,with 124 lesions in 28 months.There were 44 for homogeneous granular type,48 for nodular-mixed type,23 for flat elevated type,9 for pseudo depressed tvpe.There were 65 within 10～20 mm,23 from 21 to 30 mm,36 lesions exceeding 31 mm in the diameter of 124,the largest lesion was 110×100 mm.50 LST lesions were located in the rectum,25 in the sigmoid colon,11 lesion in descending colon,10 in the traverse colon and 28 in the ascending colon,caecum.The pit pattern was revealed under magnifying endescopy that 30 lesion swere of type ⅢL pit,including 17 tubular villous adenoma,12 tubular adenoma,56 lesions of type Ⅳ pit,including 30 villous adenoma,4 mucosal carcinoma;7 lesions of type Ⅱ pit,5 of which were inflammatory hyperplastic polyps,2 were serrated adenoma（adenomatous hyperplastic polyps）;the rest were of ⅢL＋Ⅳtype,of which 23 were tubular villous adenoma.98 lesions of 95 patients with indications for endoscopic mucosal resection were resected electively,11 of which were bleeding during the operation,none intestinal perforation.Conclusion Colorectal laterally spreading tumor（LST） has a special form of endoscopy,endoscopic mucosal resection is an effective and safe treatment for the laterally spreading tumor,which can achieve radical purpose.