结直肠锯齿状病变242例的内镜和病理学特征分析

Endoscopic and pathological features of colorectal serrated lesions:a retrospective analysis of 242 cases

目的探讨结直肠锯齿状病变的内镜下形态和组织病理学特征。方法回顾分析上海市松江区中心医院消化内镜中心2012年1月-2014年12月检出的242例结直肠锯齿状病变患者的内镜和病理学检查资料。结果242例结直肠锯齿状病变中，病变位于右半结肠74例，位于左半结肠和直肠168例；病变为隆起型145例，表面型97例，病变直径G10mm186例，10-20mm46例，〉20mm10例；腺管开口（pit）分型Ⅱ型164例，ⅢL型52例，Ⅳ型26例；结直肠锯齿状病变组织病理学特征形态为管状腺体91例，管状绒毛状腺体124例，绒毛状锯齿状腺体27例；无上皮内瘤变82例，低级别上皮内瘤变160例。病变直径G10mm的结直肠锯齿状病变以pit分型Ⅱ型为主（P〈O．01），病变直径〉20mm的结直肠锯齿状病变以pit分型ⅢL型和Ⅳ型为主（P〈0．01）；在病变直径G10mm的结直肠锯齿状病变中出现低级别上皮内瘤变者占62．37％（116／186），显著低于病变直径10-20mm的78．26％（36／46）和病变直径〉20mm的8／10（P值均〈0．05）。在pit分型为Ⅱ型的结直肠锯齿状病变中出现低级别上皮内瘤变者占55．49％（91／164），显著低于ⅢL型的88．46％（46／52）和Ⅳ型的88．46％（23／26，P值均〈O．01）。在组织病理学特征形态为管状腺体者中出现低级别上皮内瘤变者占42．86％（39／91），显著低于管状绒毛状腺体者的80．65％（100／124）和绒毛状腺体者的77．78％（21／27，P值均〈0．01）。结论结直肠锯齿状病变在结直肠息肉中占一定检出率，且具有上皮内瘤变倾向，需要引起内镜医师的重视。

Objective To explore the endoscopic and pathological features of colorectal serrated lesion. Methods In this retrospective analysis, endoscopic and pathological data were collected from 242 cases of colorectal serrated lesion found in the Digestive Endoscopy Center of Songjiang Central Hospital from January 2012 to December 2014. Results There were 74 lesions in the right hemicolon and 168 lesions in the left hemicolon. The lesion was protruded in 145 cases and superficial in 97 cases. The lesion diameter was less than 10 mm in 186 cases, between 10-20 mm in 46 cases, and more than 20 mm in 10 cases. Gland duct openings （pit type） ： 164 cases with type Ⅱ, 52 with type Ⅲ L and 26 with type Ⅳ. Pathological feature： 91 cases with tubular glands, 124 with tubulovillous glands and 27 with villous serrated glands 82 cases without intraepithelial neoplasia and 160 with low grade intraepithelial neoplasia. Colorectal serrated lesions less than 10 mm in diameter were mainly pit type Ⅱ lesions （P〈0.01）, while lesions more than 20 mm in diameter were defined as pit type L and type Ⅳ （P〈0.01）. Colorectal serrated lesions less than 10 mm in diameter with 62.37 % had low grade intraepithelial neoplasia, which was significantly lower than that of colorectal serrated lesions between 10-20 mm in diameter （78.26%） and those more than 20 mm in diameter （8/10, both P〈0.05）. The rate of low grade intraepithelial neoplasia was significantly higher in pit Ⅲ L （88.46%） and Ⅳ （88.46%） than that in pit Ⅱpatients （55.49%, both P〈0.01）. Low grade intraepithelial neoplasia was less frequently detected in tubular glands （42.86 %） than in tubulovillous （80.65 %） and villous glands （77.78 %, both P〈0. 01）. Conclusion Colon serrated lesions canbe detected in the colon polyps and has a tendency for intraepithelial neoplasia, which should be noted by endoscopic physicians. （Shanghai Med J, 2016, 39： 396-399）