放大内镜诊断大肠黏膜病变

Diagnosis of early colorectal cancers and precancerous lesions by magnifying endoscopy

目的通过放大内镜观察不同大肠黏膜病变的pit形态,探讨其用于诊断肿瘤性病变与非肿瘤性病变的准确性,研究大肠癌前病变及早期大肠癌的放大内镜下特点及其与浸润深度的关系。方法放大内镜观察病变表面结构,与病理准断结果进行对照研究。结果放大内镜诊断非肿瘤性病变(增生性、炎性、肥大赘生物)和肿瘤性病变(腺瘤和癌)的病理符合率分别为82.19%和96.05%。11个癌变病变中(8个黏膜内癌、2个黏膜下层癌、1个进展期癌),10个出现了Ⅴ型结构。30个病变同时进行了实体显微镜观察。结论放大内镜通过对pit形态的观察可以很好地区分非肿瘤性病变和肿瘤性病变。出现ⅤA型pit者多为黏膜内癌,出现ⅤN型者可能为黏膜下层癌或进展期癌。放大内镜与实体显微镜观察息肉pit形态,其结果基本一致。

[Objectives] To investigate the features of pit patterns by magnifying endoscopy on colorectal lesions especially precancerous lesions and early colorectal cancers and the relationship between pit pattern and invasive depth, and evaluate the accuracy of diagnosing neoplastic and nonneoplastic colorectal lesions by magnifying endoscopy. [Methods] The pit patterns of lesions observed by magnifying endoscopy were compared with pathological results. [Results] The diagnostic accuracy of normeoplastie lesions by magnifying endoscopy was 82.19% and 96.05% to neoplastic lesions, the overall accuracy were 84.21%. Of 11 cancerous lesions （8 intramucosal carcinomas and 2 submucosa carcinomas and 1 advanced carcinomas）, 10 showed Ⅴ pit pattern. 30 lesions were observed by stereomicroseopey, the results were similar to that of magnifying endoscopy. [Conclusions] Magnifying endoscopy can well distinguish normeoplastic lesions from neoplastic lesions. Most ⅤA pit pattern correspond to intramucosal carcinoma and it may be submucosa carcinoma or advanced carcinoma when ⅤN pit pattern appeared. The images of pit pattern obtained by magnifying endoscopy are similar to those provided by stereomicroseopy.