放大内镜对早期大肠癌及其癌前病变的诊断价值

Magnifying endoscopy in diagnosing early colorectal cancers and precancerous lesions

目的研究早期大肠癌及其癌前病变的放大内镜下特点及其与浸润深度的关系。方法应用电子放大内镜加靛胭脂染色观察了108例患者共129个大肠隆起性病变。结果129个病变中经病理诊断为肿瘤性病变(腺瘤及癌)的有106个。其腺管开口呈Ⅱ型者10个、ⅢL型者73个、Ⅲs型者1个、Ⅳ型者7个、Ⅴ型者15个,没有Ⅴ型单独存在者。10个腺管开口Ⅱ型者病变病理多为轻度异型,无重度异型。15个出现Ⅴ型结构的病变中,10例癌变,5例病理为重度异型。10个癌变病变中均出现了Ⅴ型结构,7个黏膜内癌中6个呈ⅤA型,1个ⅤN型;2个黏膜下层癌均呈ⅤN型;一个进展期癌呈ⅤN型。研究中观察到10个侧向发育型肿瘤(LST),放大内镜下腺管开口呈ⅢL型、Ⅳ型或Ⅴ型,其中1例癌变。结论放大内镜与实体显微镜观察息肉腺管开口形态基本一致。通过腺管开口观察可以很好的区分肿瘤性病变与非肿瘤性病变,其对肿瘤性病变的诊断具有重要的应用价值。

Objective To investigate the features of pit patterns by magnifying endoscopy on neo-plastic colorectal polyps. Methods The materials consisted of 129 polyps in 108 patients. Dye-assisted magnifying endoscopies were used to ascertain the pit patterns of polyps. Results Of 129 polyps, 106 were diagnosed pathologically as neoplastic lesions(adenomas and carcinomas) , in which 10 demonstratedⅡpit pattern with only mild to moderate atypia and no severe atypia; 73 ⅢL pit pattern; 1Ⅲs pit pattern; 7 Ⅳ pit pattern and 15 Ⅴ pit patterns which includes malignant change in 10 cases, and severe atypia in 5 cases. Ten lesions all demonstrated Ⅴ pit pattern were found to be carcinoma (7 mucosal and 2 submucosal and 1 advanced carcinomas). Of 7 mucosal carcinomas,6 showed ⅤA pit pattern,1 , Ⅴ N pit pattern; 2 submuco-sal carcinomas all showed VN pit pattern; 1 advanced carcinoma showed ⅤN pit pattern. Ten lateral sprea-ding tumors were also investigated, their pit patterns under magnifying endoscopy were Ⅲ LⅥor V pit pat-tern among them one case with malignant change. Conclusion The images of pit pattern obtained by magnif-ying endoscopy were essentially concordance to those provided by stereomicroscopy. The differentiation of tu-morous lesion or non-tumorous lesion can be fairly performed under the observation of pit patterns; it gives an important practical significance in diagnosing tumorous lesions.