大肠侧向发育型肿瘤的诊断及粘膜剥离切除治疗

The diagnosis and treatment of Laterally Spreading Tumor of the large intestine by magnifying chromoscopy

目的探讨放大染色内镜对大肠侧向发育型肿瘤(Laterally Spreading Tumor,LST)的诊断与治疗价值,以及LST的临床意义.方法使用日本Olympus光学仪器公司生产的CF-Q240I和CF-Q240ZI电子肠镜,对2001年12月12日至2002年7月31日在我院作肠镜检查患者(共1052例),发现病变后采用0.4％靛胭脂行病变粘膜染色,放大内镜观察,确定病变腺管开口分型;同时或择期进行注射法粘膜剥离(EMR)或注射法粘膜分片切除(EPMR)治疗.结果检出LST患者9例.检出率0.85％:其中直肠4例,乙状结肠1例,横结肠2例,升结肠2例:颗粒均一型4例,结节混合型5例;表现为III_L型腺管开口3例(33.3％),Ⅳ型腺管开口6例(66.7％)。全部病例行EMR或EPMR治疗,未发生任何出血或穿孔等并发症.结论大肠LST在我国有较高的检出率,LST与大肠癌关系密切,对其应足够重视,放大内镜结合粘膜染色技术是发现病变的重要手段,治疗上采用内镜下粘膜剥离术是安全可行的。

Objective To evalulate the clinical meaning of the Laterally Spreading Tumor (LST) of large intestine and diagnosis and treatment of it with magnifying chromoscopy. Methods 1052 patients were examined in our hospital by magnifying chromoscopy which made in Olympus Japan during the pcriod from December 12,2001 to July 31,2002.Once the lesions were detected, sprayed with Indigo Carmine (0.4%), then observed the shape of the Pit Pattern by magnifying chromoscopy. Immediate or elective endoscopic mucosa resection or partitioned mucosa resection was perfomed. Result Nine patients and nine lesions of LST were found. The lesions site of LST is 4 lesions site on return, 1 lesion site on sigmoid colon, 2 lesions site on transverse and 2 lesions site on ascending colon. 4 lesions were classified into granular homogeneous type, 5 lesions into nodular mixed type. The pit pattern on magnifying chromoscopy suggested 3 lesions of type Ⅲ_Lpit and 6 lesions of type Ⅳ. All of the 9 lesions are resected by endoscopic mucosa resection or partitioned mucosa resection. No complications occurred for the patients during treatment of EMR or EPMR such as bleeding or perforation. Conclusion The LST may be higher frequency in China. LST has a close relationship with colorectal cancer, we must pay more attention to it. Mucosa staining and magnifying chromoscopy is useful to detect LST. EMR or EPMR may consider as an good treatment of LST.