早期大肠癌的诊断及治疗

Diagnosis and treatment of early colorectal cancer

目的 探讨术前诊断早期大肠癌的方法 ,并评价其对选择治疗方式的意义。 方法 经电子、放大、超声结肠镜观察 15例大肠癌患者肿瘤的大体形态、染色后粘膜腺体开口大小排列特点、肿物浸润深度及淋巴结转移情况 ,据此对患者进行诊断和临床分期 ,并制定治疗方案。 结果 患者肿瘤直径 1～ 6cm ,以亚有蒂型最多 ,占 5 3% (8/ 15 ) ;放大内镜观察腺体开口最多见的类型为ⅢL加Ⅴ型 (8例 ,5 3% ) ;超声内镜观察粘膜癌 11例 ,粘膜下癌 4例 ,全部病例均无淋巴结转移。治疗方法包括单纯内镜下病灶切除 6例 ;内镜下病灶切除加手术切除 2例 ;手术病灶切除 7例。病理报告粘膜癌 12例 ,粘膜下癌 3例 ,超声内镜检查与病理符合率达 93%。 结论 放大内镜及超声内镜检查是确定早期大肠癌的有效方法 ,术前确定大肠癌的临床分期对指导治疗具有重要的意义。

Objectives[WT5”BZ] To study the diagnostic methods of early colorectal neoplasm before operation and to evaluate the value of these methods for selection. [WT5”HZ]Methods[WT5”BZ] Fifteen patients with early colorectal neoplasms were examined pre operatively by general colonoscopy to observe macroscopic appearance, by magnifying endoscopy to classify pit pattern type, and by endoscopic ultrasonography (EUS) to assess the penetrating depth of cancer invasion as well as regional lymph node metastases. According to these findings, diagnosis and clinical staging were made and proper treatment protocols were established. [WT5”HZ]Results[WT5”BZ] The diameter of the tumors ranged from 1 to 6 cm. Most lesions were subpedunculated type (8/15, 53%). Eight cases belongd to pit pattern type ⅢL +Ⅴ (8/15,53%). EUS showed mucosal cancer in 11 cases and submucosal cancer in 4. No lymph node metastasis was abserved in any cases. Treatment methods included endoscopic polypectomy or endoscopic mucosa resection(EMR) in 6 cases, endosurgery combined with open surgery in 2, and open surgery in 7. Pathological diagnosis showed mucosal carcinoma in 12 cases, submucosal carcinoma in 3. The accuracy of EUS was 93%. [WT5”HZ]Conclusions[WT5”BZ] Magnifying endoscopy and EUS are useful for diagnosis of early colorectal cancer before operation, and correct preoperative staging of colorectal neoplasms is of significance in guiding treatment. [WT5”HZ]