放大色素内镜在结直肠肿瘤内镜黏膜切除治疗中的应用

Application of magnifying chromoendoscopy in endoscopic mucosal resection of coiorectal neoplasms

目的评估内镜黏膜切除术（EMR）结合放大色素内镜诊治结直肠肿瘤的有效性和安全性。方法收集结肠镜检查患者中符合EMR指征的无蒂型或平坦、凹陷型病灶。观察病灶形态学与EMR术后组织学结果的相关性，评估放大色素内镜判断病灶浸润深度的准确性。结果81例患者经EMR切除病灶90个（无蒂型25个，平坦、凹陷型65个）。组织学显示低级别上皮内瘤变（LGD）58个，高级别上皮内瘤变（HGD）20个，腺癌12个。其中HGD和癌变病灶直径大于LGD病灶[（1．4±0．5）cm和（1．6±0．5）cm比（1．0±0．4）cm]，但组间差异无统计学意义（P〉0．05）。平坦、凹陷型病灶较无蒂型病灶更易出现HGD或癌，但差异亦无统计学意义[41．5％（27／65）比20．0％（5／25），P=0．084]。病灶表面有凹陷者出现HGD或癌的比例显著高于无凹陷者[51．0％（25／49）比17．1％（7／41），P〈0．01）]。放大色素内镜判断病灶浸润深度的准确性为97．8％（88／90）。完整的组织学切除占所有病灶的95．6％（86／90）。结论凹陷型和平坦型伴中央凹陷的结直肠病变的恶性倾向高。应用放大色素内镜能准确判断病灶浸润深度，从而使EMR治疗更安全有效。

Objeclive To evaluate the clinical efficacy and safety of endoscopic mucosal resection （EMR） assisted with magnifying chromoendoscopy in treatment of colorectal neoplasms. Methods Patients who met criteria for EMR including appropriate flat or depressed type and sessile lesions were enrolled. The association of morphology of colorectal lesions with histopathology was observed and the accuracy of estimation of invasive depth by magnifying chromoendoscopy was evaluated. Results Ninety lesions of 81 patients were resected by EMR （25 being sessile and 65 being flat or depressed）. The histological results revealed low-grade dysplasia （LGD） in 58 lesions, high-grade dysplasia （HGD） in 20 lesions, and adenocarcinoma in 12 lesions. The average size of lesions was （1.4±0.5） cm in HGD, （1.6±0.5） cm in cancer and （1.0±0.4） cm in LGD with no significant difference （P〉0.05）. It was shown that the flat and depressed lesions were more likely to be HGD or cancer as compared to sessile lesions, but with no statistical difference [41.5%（27/65）vs. 20.0%（5/25）,P= 0. 084]. Moreover, the lesion with central depression was more likely to be HGD or cancer as compared to those without depressed surface [51.0% （25/49） vs. 17. 1%（7/41）,P〈0.01）]. The accuracy of estimating invasive depth by magnifying chromoendoscopy was 97.8% （86/90）. Complete resection was confirmed histologically in 95.6 ~ （88/90） of all lesions. Conclusions Colorectal lesions of depressed and flat types with central depression are more likely to be malignant. Estimation of invasive depth of colorectal neoplasia by magnifying chromoendoscopy in EMR treatment makes it more effective and safer.