结直肠高级别上皮内瘤变的临床分析38例

目的:研究结直肠高级别上皮内瘤变的临床病理特征,探讨临床合理治疗决策.方法:回顾性总结38例经内镜检查和病理初步诊断为结直肠高级别上皮内瘤变患者的,临床资料,分析其临床表现、内镜形态学、组织病理学特点、预后等,随访观察3-36 mo.结果:38例患者中,最终确诊17例为结直肠癌.21例仍为高级别上皮内瘤变.治疗前后诊断一致性较差(Kappa值为0.376).结直肠高级别上皮内瘤变合并癌的高危因素包括:肿瘤大小、内镜形态特点、症状严重、绒毛状腺瘤合并高级别上皮内瘤变、CEA或CA19-9增高等.结论:使用WHO新的诊断结直肠高级别上皮内瘤变需引起临床医生重视,特别是对于内镜下单纯活检病例.应当谨慎选择治疗方式和随访时间.

Clinicopathologic characteristics of high-grade colorectal intraepithelial neoplasia: analysis of 38 cases

AIM:To reveal the clinicopathological features of high-grade colorectal intraepithelial neoplasia and discuss treatment strategy. METHODS:Thirty-eight cases of high-grade colorectal intraepithelial neoplasia diagnosed by colonoscopy biopsy were treated and followed up for 3 to 36 months.A retrospective review of clinical findings,endoscopic and histopathologi- cal features,and prognosis was used to determine appropriate treatment and follow-up for high- grade colorectal intraepithelial neoplasia. RESULTS:Among the 38 patients,17 under- went a preoperative endoscopic biopsy and agreed to a surgical operation;lesions in 19 cases were endoscopically resected,while the remaining 2 cases just agreed to being followed- up.Seventeen cases were diagnosed with a ma- lignant carcinoma,and 21 eventually showed high-grade colorectal intraepithelial neoplasia. Pathological diagnosis pre- and post-treatment showed poor consistency;the Kappa value was 0.376,and in the cases of endoscopic clamping biopsy it was 0.580.Of the patients undergo- ing surgical or endoscopic treatment,one with malignant carcinoma had liver metastasis,and one suffered a recurrence 11 months later.One case with high-grade colorectal intraepithelial neoplasia was found to have an adenocarcinoma at a previous endoscopic resection site after 3 months.There were no new tumors in the other cases during 3 years of follow-up.In accordance with the characteristics of carcinoma cases,can- cer risk appears related to tumor size,endoscop- ic features,severity of clinical symptoms,the villous morphology of biopsy pathology,and a high level of CEA or CA19-9. CONCLUSION:Close attention needs to be paid when using the WHO's new diagnostic stan- dards of high-grade intraepithelial neoplasia instead of the prestage of tumors of the diges- tive system.Clinicians should be careful when choosing treatment for high-grade intraepithe- lial neoplasia,especially in cases of endoscopic clamping biopsy.