染色放大内镜下大肠黏膜表面微细结构改变及其临床病理意义

目的通过染色放大内镜观察不同大肠黏膜病变的Pitpattern形态,探讨其在早期大肠癌诊断中的应用价值。方法应用染色放大内镜对146例患者的大肠黏膜进行细微结构形态学观察,并与观察部位活检所得的病理组织学改变进行比较分析。结果 146例患者中放大内镜检出息肉172枚,经0.2%的靛胭脂染色放大后又发现0.1～0.5cm大小的息肉84枚,共计息肉样病变256枚。染色放大内镜可明显提高息肉病变的检出率。各种腺管开口分型的病理诊断结果构成差异有显著性,Ⅰ～Ⅴ分型与病变严重程度之间呈明显正相关。染色放大内镜对大肠肿瘤性病变诊断符合率89.5%、敏感性82.2%、特异性92.3%,放大内镜诊断符合率71.5%、敏感性61.8%、特异性77.9%,染色放大内镜对大肠肿瘤性疾病诊断与放大内镜相比差异具有统计学意义（P〈0.01）。结论染色放大内镜对大肠肿瘤的诊断优于放大内镜,能够提高大肠癌的早期诊断率,从而为大肠癌及其癌前病变的内镜下正确处理提供快速而准确的依据。

Microstructural changes of colorectal carcinoma by magnifying chromoendoscopy and its clinicopathological significances

Objective To study the clinical value of magnifying chromoendoscopy in detection and diagnosis of early colorectal lesions.Methods The observation of lesions by magnifying chromoendoscopy was compared with pathological results.Results One hundred and seventy-two po1ypoid lesions were found by magnifying endoscopy in 146 patients.Eighty-four more lesions with a size of 0.1 ～ 0.5 cm were discovered by chromoendoscopy with indigo carmine.The detection rate of adenomatous lesion was obviously increased by magnifying chromendoscopy.Statistical difference was found between pit patterns and histopathological features,Ⅰ～Ⅴ type of pit patterns has certain correlation with the severity of pathologic diagnosis.The coincident rate of magnifying chromoendoscopy for the diagnosis of tumor and non-tumor lesions was 89.5% which was significantly higher than magnifying endoscopy’s 71.5%(P < 0.01);The sensitivity and specificity of the magnifying chromoendoscopy for the diagnosis of tumor and non-tumor lesions were 82.2% and 92.3% respectively,while the magnifying endoscopy were 61.8%、77.9% respectively (P < 0.01).Conclusions The superiority of the magnifying chromoendoscopy was higher for diagnosis of colorectal carcinoma which not only enhances the early diagnosis of colorectal cancer but also provide a quick and accurate basis for endoscopic treatment of colorectal cancer and precancerous lesions.