403例大肠侧向发育型肿瘤内镜下诊治分析

Endoscopic diagnosis and treatment of 403 cases of laterally spreading tumor in colon

目的探讨大肠侧向发育型肿瘤（LST）的临床、病理特征及内镜黏膜下剥离术（ESD）的有效性、安全性。方法中国医科大学附属第一医院内镜科2014年4月至2016年12月经结肠镜检查共发现376例403处LST病变，观察病变部位、大小并进行形态分型。其中143例160处病变行内镜下治疗，行内镜下治疗的病变均在内镜下观察腺管开口类型，切除的病灶行病理组织学检查。术后定期随访。结果403处LST的病变部位以直肠为主，共168处（41．69％）；直径10～〈20mm的病变最多，共150处（37．22％）；形态分型以结节混合型为主，共203处（50．37％）；病理以低级别瘤变为主，达65．51％（264／403）。随着LST病变直径的增加，其恶性潜能也随之上升（P〈0．05）。非颗粒型比颗粒型的病变恶性潜能更高（P〈0．05）。376例403处病变中128例145处病变择期行ESD治疗，术中发生出血12例，无延迟出血、肠穿孔发生。行内镜治疗的160处LST中腺管开口为Ⅳ型的最多，达70．62％（113／160），腺管开口为V型的LST的癌变率最高，达80．00％（8／10）。随着LST腺管开口类型的升级，病理的恶性程度（P〈0．05）及癌变的浸润程度（P〉O．05）表现出增加的趋势。行ESD治疗的128例患者中113例按期复查，其中2例复发。余未复发患者创面愈合良好。结论大肠LST的临床病理特征具有一定特殊性，ESD是治疗LST有效而安全的方法，可达到根治目的。

Objective To explore the clinical and pathological features of laterally spreading tumor （LST） in colon, and the efficacy and safety of endoscopic submucosal dissection （ESD）. Methods A total of 376 cases with 403 lesions of LST were detected by colonoscopy in the First Hospital of China Medical University from April 2014 to December 2016. The site, size and classification of all lesions were recorded. One hundred and sixty lesions in 143 patients underwent endoscopic treatment, and Their pit pattern were observed. The resected lesions were sent for pathological examination. The patients were followed up regularly after treatment. Results Among 403 cases of LST, 168 lesions （41.69%） were located at rectum, which was the main site. Lesions with diameter of 10-〈20 mm were of the largest number （37.22%, 150/403）. Nodular mixed type was the main morphologic type with a total of 203 lesions （50. 37%）. The main pathologic type was low-grade adenoma （65.51%, 264/403 ）. The malignant potential rose with the increase of diameter of LST lesion （P〈0. 05）. Compared with the LST granular type, LST non-granular type had a higher pathologic malignant potential （P〈0. 05）. Among 403 lesions in 376 patients, 145 lesions in 128 patients were treated by ESD. Intraoperative bleeding occurred in 12 patients, and no delayed bleeding or perforation occurred. Among the 160 treated LST cases, 1V-type pit pattern was of the largest number, up to 70. 62% （113/160）. The canceration rate of V-type pit pattern was the highest, up to 80.00% （8/10）. Malignant degree of pathology （ P〈0. 05 ） and penetration degree of cancer （ P〉0. 05 ） showed an increasing trend with the upgrade of pit pattern of LST cases. Among the 128 patients who were treated by ESD, 113 cases were regularly reexamined, and 2 cases relapsed. Others whose wounds didn＇t relapse healed well. Conclusion The clinical and pathological features of colorectal LST are unique. ESD is an effective and safe treatment for LST, which can achieve radical results.