大肠黏膜病变腺管开口类型及其与微血管密度的关系

Contrast study on colorectal mucosal lesions′ magnifying endoscopic features with its microvessel density

目的探讨染色放大内镜下大肠黏膜腺管开口类型及其与微血管密度(MVD)的相关性,为进一步研究大肠癌发生发展提供理论依据。方法对普通电子结肠镜检查发现的176例结肠黏膜外观异常的患者及15例结肠黏膜外观正常的病例,应用染色放大内镜,结合化学染色,对大肠黏膜腺管开口行Kudos分型,病变黏膜随后行黏膜活检或黏膜切除、常规病理检查及免疫组化测量其MVD;分析黏膜腺管开口类型与MVD的关系。结果 176例大肠黏膜病变中,染色放大内镜发现腺管开口形态为Ⅰ型27例、Ⅱ型35例、ⅢL型54例、Ⅳ型49例和Ⅴ型11例;病理诊断黏膜炎性病变28例,增生性息肉36例,管状腺瘤53例,绒毛状腺瘤48例及大肠癌11例;15例正常黏膜腺管开口均为Ⅰ型,炎性病变腺管开口以Ⅰ型为主,增生性息肉腺管开口以Ⅱ型为主,管状腺瘤和绒毛状腺瘤的腺管开口分别以ⅢL型和Ⅳ型为主,11例大肠癌则均表现为Ⅴ型腺管开口,黏膜腺管开口类型与大肠癌变之间具有相关性(rp=0.964,P<0.001),且大肠黏膜病变腺管分级与MVD值也呈正相关,分级越高,MVD值也越高(rp=0.943,P<0.001)。Ⅴ型腺管开口MVD值显著高于其他类型开口(P<0.05);当MVD值≥30时,有助于大肠癌的诊断。结论大肠黏膜腺管开口类型与组织病理学改变及MVD均有明显相关性,MVD越高癌变可能性越大,腺管开口形态联合MVD,有助于大肠癌的早期诊断。

Objective To explore the correlation between pit patterns of colorectal mucosal lesions classified by magnifying chromoendoscopy and the microvessel density （MVD）. Methods After conventional electronic colonoscopic diagnosis of 191 patients, 176 cases of abnormal mucosa and 15 cases of normal mucosa were sprayed and magnified by magnifying chromoendoscopy, and colorectal lesions in 176 patients were classified as type I to V pit patterns by magnifying chromoendoscopy using the Kudo criteria;biopsy specimen or resected samples were sent for pathologic examinations and the relationship between the results of the examinations and pit patterns were analysed. All the slices of the lesions were stained immunohistochemistry with anti-CD34 monoclonal antibody and MVD were calculated separately, and the relationship between MVD and the type of pit patterns were analysed. Results Among the 176 cases ,27 cases of type I ,35 cases of type II ,54 cases of type III L ,49 cases of type IV and 11 cases of type V were observed. After the pathologic examinations, there were 28 cases of mucosal inflammation lesions ,36 hyperplastic polyps,53 tubular adenomas,48 villous adenomas,and 11 colorectal cancers were found;the pit pattern of the 15 normal mucosas was type I , those of most mucosal inflammation lesions, hyperplastic polyps, villous adenomas and tubular adenomas were type I ,type Ⅱ ,typeⅢL and type lVrespectively,and that of all the cancers was type V. There was significant correlation between the pit pattern type and the pathologic diagnosis （rp = 0. 964, P 〈 0. 001 ）. There was also significant correlation between the pit pattern type and the MVD（ rp =0. 943 ,P 〈0. 001 ）. The MVD of type I to V lesions were smaller than that of type V （ P 〈 0. 05 ） ; and when the count of MVD was not smaller than thirty, it might help us to diagnose colorectal cancer. Conclusions There is significant correlation between the pit pattern type and the pathologic change, and there is significant correlation between the pit pattern type and the MVD. MVD isclosely related with the incidence and development of colorectal cancer. Pit pattern together with MVD can be helpful to diagnose early eoloreetal cancer.