肠镜下黏膜平坦型病变的临床意义

The clinical significance of colorectal fiat lesions under endoscopy

目的应用放大内镜结合黏膜染色技术寻找平坦型病变,比较大肠黏膜隆起型病变与平坦型病变肿瘤情况。方法 16 457例患者通过放大结肠镜检查来寻找大肠隆起型与平坦型病变。记录患者年龄、性别等资料,对大肠隆起型和平坦型腺瘤性息肉的发生率、内镜下表现、病理类型进行分析。结果 (1)共检出腺瘤和癌变2218例,平坦型170例(7.67%)。(2)隆起型肿瘤平均直径为(29±9)mm,平坦型肿瘤平均直径为(17±14)mm。(3)隆起型和平坦型肿瘤发生在左侧结肠分别为1630例(79.59%)和140例(82.35%)。(4)隆起型和平坦型肿瘤性病变中发生管状腺瘤,绒毛状腺瘤和混合状腺瘤的例数分别为1051例(51.34%)和95例(55.55%),87例(4.25%)和29例(19.96%),180例(8.79%)和30例(17.54%)。(5)隆起型和平坦型腺瘤中轻度不典型增生,中度不典型增生,重度不典型增生和早期癌变例数分别为638例(31.15%)和44例(25.88%),337例(16.46%)和34例(20.00%),45例(2.20%)和16例(9.41%)。结论重度不典型增生和早期癌变率的发现率平坦型病变明显高于隆起型病变。大肠黏膜腺瘤平坦型病变与隆起型病变相比,恶性程度更高。

Objective To identify flat lesion in colon and rectum with combination of magnifying endoscope and mucosa staining technique ad to compare the differences between the protruded and flat colorectal lesions. Methods 16 457 consecutive patients with colorectal lesions underwent magnifying endoscopy and mucosa staining to detect protruded and flat colorectal lesions. The clinical data were analyzed. Results （ 1 ） A total of 1472 adenoma cases were found; 154 （ 10.46% ） of which were of the flat type. （2）The average size of flat adenoma was （17 ± 14）mm, significantly smaller than that of polypoid adenoma [ （29 ±9） mm, P 〈0.05） ]. （3） The incidence of colorectal tumor in the left colon was 82.35% （140/170） in the flat type tumor, significantly higher than that in the protruded type tumors （79.59%, 1630/2048, P=0.013）. （4） The incidence rates of tubular adenoma, tubulo-villous adenoma , villous adenoma, and cancer were 51.34%, 4.25%, 8.79% , and 35.65% respectively in the protruded type tumor, and were 55.55%, 17.06%, 17.64%, and 9. 43% respectively. The detection rates of mild, moderate, and severe dysplasia and early cancer were 31. 15%, 16. 46%, 2. 20%, and 2. 59% respectively in the protruded type tumor, and were 25.88% ,20.00% ,9.41%, and 8.62% respectively in the flat type tumor. Conclusion The detection rates of moderate and severe dysplasia and early colorectal cancer in the flat adenomas are higher than in the protruded adenoma. Of higher malignancy grade, flat adenomatous lesions are more likely to be carcinomatous compared with the protruded adenomatous lesions.