大肠侧向发育型肿瘤(LST)早期癌变8例内镜下治疗及随访

Endoscopic mucosal resections and follow-up study for 8 patients with colonic laterally spreading tumors with early carcinomatous change

目的 探讨大肠侧向发育型肿瘤(LST)早期癌变在内镜下治疗的新方法及疗效。方法 采用放大大肠镜与黏膜染色技术观察黏膜pit分型 ,发现LST早期癌变 ,并采用内镜下黏膜剥离切除术(EMR)对LST早期癌变进行治疗且随访疗效。结果 8例LST早期癌变主要分布在直肠、乙状结肠和降结肠 ,占 75 % ;病变大于 30mm以上者占 75 % ;放大内镜下病变pit分型以Ⅳ型为主 ,占 75 % ;病理形态以绒毛状腺瘤癌变为主 ,占 6 2 5 % ,浸润深度以黏膜内癌为主 ,占 75 % (m +sm1占 87 5 % )。8例早期病变均进行EMR ,一次性完全切除成功 ,其中EMR和内镜下分片黏膜剥离切除术 (EPMR)各 4例。平均随访 2 0 7个月 ,随访期间均未发现肿瘤局部残留、复发及转移。结论 大肠侧向发育型肿瘤早期癌变多为黏膜内癌 ,内镜下行EMR是一种有效的或可能治愈的方法。

Objective To eraluate the methods and results of endoscopic mucosal resections for colonic laterally spreading tumors with early malignant degeneration. Methods The pit pattern was studied with magnitying colonoscopy and mucosal staining technique for colonic laterally spreading tumors (LST) undergoing early earcinatous degeneration. They were removed with endoscopic mucosal resection techniques. A follow-up study was made. Results Eight patients suffering from early carcinoma on top of colonic laterally spreading tumors were followed-up. ① 75% of the lesions were situated in the rectum, sigmoid colon and decending colon. ② 75% of the lesions were larger than 30mm in diameter. ③ 75% of the lesions belonged to Ⅳpit pattern. ④ 62.5% of the lesions were Villous adenomas and 75% of the onalignant change involved the mucosa only. ⑤ All the lesions were completely removed by EMR, ⑥ No local residual lesion, recurrence or metastasis was discovered in all the patients after a mean follow-up period of 20.7 months. Conclusions Most of the early carcinomas originated from colonic LST involved the mucosa only. Endoscopic mucosal resection may be a curative method for the early cancer arising from colonic LST.