结肠平坦型病变放大内镜下粘膜染色后剥离切除与高频电灼的效果对比

Comparison of curative effect for colon flat lesion between mucosa resection and fulguration with high frequency current after mucosa staining under magnifying endoscope

目的 观察结肠平坦型病变腺管开口分型与病理学的关系 ,同时对比剥离切除与高频电灼的效果。方法 高频电灼组 (A组 ) 37例 ,剥离切除组 (B组 ) 34例。检查为单人操作法 ,检查中发现结肠平坦型病变者 ,放大图像观察 ,靛胭脂染色后 ,对腺管开口进行Pit分型。A组活检后用高频电探头灼除病灶 ,B组行剥离切除后将切下的标本送组织学检查。结果 (1) 71例病人 ,炎性和增生性病变腺管开口以PitⅡ型为主 ,腺瘤以ⅢL、Ⅳ型为主 ,有癌变者以Ⅳ、Ⅴ型为主 ;病变越接近肿瘤 ,Pit分型越高。 (2 )两组的病灶数、分布、息肉类型、并发症差异均无显著意义 (P >0 0 5 )。但高频电灼组活检的 2 1例腺瘤未发现恶变 ,而剥离切除组的 2 0例腺瘤中 4例发现恶性病变 (均为腺癌 )。结论 (1)病变越接近肿瘤 ,腺管开口Pit分型越高。 (2 )平坦型病变剥离切除与高频电灼的有效性和安全性无明显差异。但前者能发现残留病灶 ,可再次切除 。

Objective To observe the relationship between the pit patterns and pathology and compare the curative effect for colon flat lesion between endoscopic mucosa resection (EMR) and fulguration with high frequency current (FHFC). Methods They were divided to two groups. There were 37 cases for FHFC in group A, and 34 cases for EMR in Group B. The two groups were comparabal. Examining patients suffering with colon flat lesions with magnifying endoscope and observing the pit patterns of mucosa after staining with indicarmine. Results The pit patterns of inflammatory or hyperplastic lesions were mainly pit Ⅱ, adenoma pit Ⅲ and pit Ⅳ, and carcinomatous lesions pit Ⅳ and pit Ⅴ.The worse the differentiation degree of lesions was,the higher the pit patterns were. There were no difference ( P >0.05) between group A and B in complication and quantity, classification and distribution of lesions. .No canceration was detected in 21 cases with adenoma in group A, while 4 cases of canceration ( all were adenocacinoma) was found in 20 cases whith adenoma in group B. There was significance in canceration between two groups ( P <0.05). Conclusions The worse the differentiation degree of lesions was, the higher pit patterns were. EMR and FHFC share the same validity and security when treating the flat lesions, but by EMR, doctors could judge whether the lesions were resected completely, once the remained lesions were found, they could be resected immediately again lesion in case of omission of canceration.