大肠侧向发育型肿瘤的放大内镜及病理特征分析

目的探讨大肠侧向发育型肿瘤（LST）的镜下形态、腺管开口类型和病理特征间的关系。方法对10例LST可疑病变行0.3%靛胭脂喷洒染色,确定病变范围后以放大肠镜观察腺管开口类型,作病理活检并与术后病理类型对照。结果10例LST患者内镜下大体形态分型：颗粒均一型3例,结节混合型6例,扁平隆起型1例。腺管开口类型：ⅢL型4例,Ⅳ型6例,未发现Ⅴ型腺管开口。术后病理类型：管状腺瘤4例,伴腺体轻度异型增生;管状绒毛状腺瘤5例,均伴腺体中-重度异型增生,其中1例合并粘膜内癌;绒毛状腺瘤1例,腺体重度异型增生,伴黏膜内癌。术前内镜活检与术后病理结果一致者仅3例。结论大肠侧向发育肿瘤并非少见。内镜下黏膜染色结合放大内镜观察可有效确定病变范围、形态和腺管开口类型,初步判定病理类型以指导治疗。LST镜下形态以结节混合型多见,术后病理类型多为管状绒毛状腺瘤。腺管开口类型多为Ⅳ型。Ⅳ型腺管开口的病变也可合并早期大肠癌。内镜下活检不能代替术后病理检查。

Pathological features of laterally spreading large bowel neoplasm observed with magnifying endoscopy

Objective To observe the general shape, pit patterns and pathological features of laterally spreading large bowel neoplasm （LST）. Methods 0.3% indigocarmine staining was applied in suspicious mucosal lesions such as flat mucosal protrusion, rough surface, disappearance of capillary network in 1247 cases of routine colonoscopy, Pit patterns were observed by magnifying endoscope. Pathological biopsy was performed and compared with pathological diagnosis after treatment. Results 10 cases were found as LST, including 7 cases of single lesion and 3 case accompanied by other types of polyps. 4 LST lesions located in the rectum, 3 in the slgmold colon, 1 in the traverse colon and 2 in the ascending colon, According to the endoscopic morphology, 3 lesions were classified as the granular homogeneous type, 6 lesions as nodular mixed type and 1 lesion into even protrusive type. The pit pattern observation showed 4 lesions of Ⅱ-L type and 6 lesions of Ⅳ type, but no V type was found. Conclusion The LST was not unusual. Endoscopic mucosal staining combined with magnifying endoscopy could outline lesion effectively and determine pathological type.