早期大肠癌的诊断及治疗

目的 探讨术前诊断早期大肠癌的方法,并评价其对选择治疗方式的意义。方法 经电子、放大、超声结肠镜观察１５例大肠癌患者肿瘤的大体形态、染色后粘膜腺体开口大小排列特点、肿物浸润深度及淋巴结转移情况,据此对患者进行诊断和临床分期,并制定治疗方案。结果 患者肿瘤直径１～６ｃｍ,以亚有蒂型最多,占５３％（８／１５）;放大内镜观察腺体开口最多见的类型为ⅢＬ加Ⅴ型（８例,５３％）;超声内镜观察粘膜癌１１例,粘膜

Diagnosis and treatment of early colorectal cancer

OBJECTIVES: To study the diagnostic methods of early colorectal neoplasm before operation and to evaluate the value of these methods for selection. METHODS: Fifteen patients with early colorectal neoplasms were examined pre-operatively by general colonoscopy to observe macroscopic appearance, by magnifying endoscopy to classify pit pattern type, and by endoscopic ultrasonography (EUS) to assess the penetrating depth of cancer invasion as well as regional lymph node metastases. According to these findings, diagnosis and clinical staging were made and proper treatment protocols were established. RESULTS: The diameter of the tumors ranged from 1 to 6 cm. Most lesions were subpedunculate type (8/15, 53%). Eight cases belonged to pit pattern type III L + V (8/15, 53%). EUS showed mucosal cancer in 11 cases and submucosal cancer in 4. No lymph node metastasis was observed in any cases. Treatment methods included endoscopic polypectomy or endoscopic mucosa resection (EMR) in 6 cases, endo-surgery combined with open surgery in 2, and open surgery in 7. Pathological diagnosis showed mucosal carcinoma in 12 cases, submucosal carcinoma in 3. The accuracy of EUS was 93%. CONCLUSIONS: Magnifying endoscopy and EUS are useful for diagnosis of early colorectal cancer before operation, and correct preoperative staging of colorectal neoplasms is of significance in guiding treatment.