大肠黏膜表面结构对早期大肠癌及其癌前病变的诊断价值

Pit pattern classification for diagnosis of early colorectal cancers and precancerous lesions

目的 探讨大肠黏膜病变表面腺管开口分型对早期大肠癌及癌前病变的临床应用价值.方法 应用电子放大内镜结合黏膜染色方法观察了144例患者共162处大肠黏膜病变,并结合病变大体形态特点及病理组织学结果进行分析.结果 162处病变中非肿瘤性病变表现为Ⅰ型及Ⅱ型腺管开口者占76.5%（26/34）;肿瘤性病变表现为Ⅲ、Ⅳ和Ⅴ型腺管开口者占96.1%（123/128）.癌性病变则主要以Ⅴ型腺管开口为主,占75.0%（9/12）,其中3例进展期癌均表现为ⅤN型腺管开口.结论 大肠黏膜腺管开口分型对判断非肿瘤性病变、肿瘤性病变及早期大肠癌具有重要意义,并对临床治疗方式的选择具有指导意义.

Objective To evaluate pit pattern analysis for detection of early colorectal carcinoma and precancerous lesions. Methods A total of 162 lesions in 144 patients were examined with magnifying colonoscopy after staining, and their pit patter was analyzed with morphology and pathologic diagnosis. Results With confirmation of pathology, there were 34 non-neoplastic lesions and 128 neoplastic ones, in which 12 were carcinomas. The pit patterns in most non-neoplastic lesions （76. 5%, 26/34） were type Ⅰ or Ⅱ , and those in most neoplastic lesions （96. 1% , 123/128） was type Ⅲ, Ⅳ or Ⅴ. Pit patterns of cancerous lesions were mainly type Ⅴ （75.0%, 9/12）, and those of 3 cases of advanced cancers were all type Ⅴ N. Conclusion Pit pattern classification is a very important tool to differentiate between neoplastic, nonneoplastic lesions and early cancer, which helps to decide later therapeutic intervention.