结直肠上皮内瘤变病理诊断意义的探讨

Discussion on the significance of diagnosis in colorectal intraepithelial neoplastia

目的探讨结直肠上皮内瘤变病理诊断的临床意义和外科治疗的原则。方法江苏大学附属上海第八医院于2004年1月至2006年12月共收治术前经内镜活检,病理诊断为"上皮内瘤变"的病例共96例,其中诊断为低级别上皮内瘤变47例,高级别上皮内瘤变49例。行腺瘤切除术2例,根治性结肠切除手术31例,直肠低位前切除术43例,经肛门局部切除术10例,Hartmann直肠经腹切除结肠造口术1例,腹会阴切除术2例,Parks结肠肛管吻合术7例。结果术后62例(64.58%)病理证实为浸润性腺癌,49例术前诊断为高级别上皮内瘤变的腺瘤中89.80%术后病理是腺癌。在低级别上皮内瘤中亦有38.29%的浸润性癌。在62例腺癌中1例伴有肝转移,2例有邻近组织转移,术后病理证实有局部淋巴结转移或见癌结节17例(17/62,27.4%)。结论要重视结直肠上皮内瘤变的病理诊断,高度警惕高级别上皮内瘤变实际为浸润性癌的可能性极大,如果肿瘤的位置不涉及保肛的问题,宜首选作病变肠段切除,如术中可确诊为浸润性癌,则应行根治性切除手术。

Objective To discuss the clinical significance of pathological diagnois in colorectal intraepithelial neoplasia and the principles of surgical treatment. Methods Ninty-six patients with colorectal tumors were treated in Shanghai the 8th People＇s Hospital from January 2004 through December 2006. They was diagnosed as ＂intraepithelial neoplasia＂ by preoperative endoscopic biopsy. Among these cases ,47 cases were diagnosed as low grade intraepithelial＂ neoplasia, and 49 cases were high grade intraepithelial neoplasia. Two patients with adenoma were treated by polypectomy ,22 patients treated by colectomy,43 patients treated by low anterior resection （LAR） ,8 patients treated by ia 38.29% were infiltrative carcinoma. Results In 62 cases confirmed as adenocarcinoma, 1 had liver metastasis ,2 had involved adjacent tissues and 17 cases （64. 58% ） had reginonal lymph nodes metastasis. Conclusion It should pay much attention to the pathological diagnosis in colorectal intraepithelial neoplastia, especially in the high grade intraepithelial neoplasfia. If the location of the tumor was not involved to anal sphincter and in highly suspected case with malignant potiential, It prefer to treat with segmental resection of the bowel rather than local excision or polypectomy.