结肠脂肪瘤6例

Colonic lipoma: an analysis of six cases

目的:探讨结肠脂肪瘤的临床特点及误诊原因,以提高诊断率.方法:调阅病历、结肠镜、腹部CT、结肠钡剂造影图像、结肠镜活检病理切片、手术切除标本病例切片等资料.对我院1995-2010年病理确诊的6例结肠脂肪瘤病例的临床、内镜下、影像学表现、病理图片及误诊原因进行回顾性分析.结果:3例行结肠钡剂造影,见结肠充盈缺损,诊断结肠癌;1例行腹部CT检查,诊断结肠息肉;6例均行结肠镜检查,均发现结肠黏膜下肿块;诊断结肠癌3例、结肠息肉2例、结肠脂肪瘤1例.6例患者中,仅1例术前获确诊.误诊率83.3%(5/6).误诊原因主要有:该病发病少,临床少见;临床表现无特异性;瘤体表面因炎症、糜烂等,失去内镜下典型表现而酷似结肠癌;医生对本病认识不足.结论:内镜检查时结肠脂肪瘤瘤体同一部位多次深挖活检应可做出正确诊断.治疗可根据情况行内镜下高频电切除或行手术作肠段切除术.

AIM: To summarize the clinical features of colonic lipoma and to analyze reasons for misdiagnosis of this disease. METHODS: The clinical data for six patients with colonic lipoma who underwent treatment at our hospital from 1995 to 2010 were reviewed retrospectively to analyze the iconographic and clinicopathologic characteristics of the disease and the reasons for misdiagnosis. RESULTS: Three patients initially diagnosed with colonic carcinoma at barium enema examination revealed a radiolucent spherical filling defect with well-defined margins. One patient was initially diagnosed with colonic polyposis by abdominal CT scanning. In all patients, colonoscopy revealed a lump located in the submucosa of the colon. Of six patients, one was diagnosed with colonic lipoma, three were misdiagnosed with colonic carcinoma, and two were misdiagnosed with colonic polyposis. Only one case was accurately diagnosed before hemicolectomy, and the misdiagnosis rate was 83.3%. The reasons for misdiagnosis included rarity, unspecific clinical manifestations, absence of typical endoscopic findings because of inflammation and erosion of tumor surface, and docter’s insufficient knowledge of colonic lipoma. CONCLUSION: Correct diagnosis of colonic lipoma can be achieved by multiple endoscopic biopsies. Endoscopic electroresection or local intestinal resection can be selected in patients with colonic lipoma.