内镜下黏膜染色加黏膜切除对大肠侧向发育肿瘤的诊断治疗

目的探讨电子肠镜下靛胭脂黏膜染色联合黏膜切除对大肠侧向发育肿瘤（LST）诊治的临床价值。方法对4200例肠镜检查中发现的可疑黏膜病灶，行镜下喷洒0．4％靛胭脂黏膜染色，镜下观察病灶大小并形态分型，病灶黏膜可随充吸气变形者及黏膜下注射液体黏膜抬举征呈阳性者行内镜黏膜切除（MER）或分片黏膜切除术（EPMR），未能行黏膜切除者行镜下活检，病灶黏膜送病理检查。结果发现45例患者共47个LST病灶，检出率为l、l％。分型；颗粒型33（70．2％）和非颗粒型14（29、8％）。大小；10～19mm25个（53．2％），20～30mm14个（29．8％），〉30mm8个（17．0％）。病理检查黏膜局部癌变7例（5例SM癌，2例sML癌），LST病灶中早期大肠癌捡出率为14．9％，进展期大肠癌3例，良性腺瘤37个（78．7％）。结论普通电子肠镜结合黏膜染色能够有效的发现大肠LST病灶，联合镜下黏膜切除根除LST病灶对早期大肠癌防治具有积极临床意义。

The diagnosis and treatment of Laterally Spreading Tumor by endoscopic mucosal resection and chromoendoscopy

Objective To evalulate the clinical value of endoscopic mucosal resection and chromoendoscopy in the diagnosis and treatment of Laterally Spreading Tumor of the large intestine.Methods 4200 patients were examined in our hospital by endoscopic chromoscopy.Once the lesions were detected,sprayed with Indigo Carmine(0.4%),the size and morphous type of Laterally Spreading Tumor of the large intestine was observed by enteroscope.The shape change of lesions was detected by insufflation and deflation of air or injection of submucosa.Lesions were treated with endoscopic mucosal resection(EMR)technique or piecemeal EMR method.The lesions which were not treated with EMR or EPMR were performed with endoscopic mucosal biopsy.The pathology diagnosis was then performed.Result 47 lesions of LST were found.The detection rate was 1.1%.33 lesions were classified as granular type(70.2%),14 lesions as nongranular type(29.8%).The size of 25 lesions was from 10 to19mm,and 14 lesions from 20 to 30mm,8 lesions lager than 30mm.The pathological diagnosis revealed that 7 lesions had early malignant degeneration(5 intramucosal cancer and 2 submucosal cancer).The detection rate of early colorectal cancer in all LST was 14.9%,in which 3 lesions were progressive colorectal cancer,and 37 lesions were innocence adenoma.Conclusion Endoscopic mucosa chromoscopy is effective in detecting LST.EMR or EPMR may be considered as a good treatment method for early colorectal cancer.