大肠黏膜腺管开口分型对大肠肿瘤性病变的诊断意义

THE DIAGNOSTIC SIGNIFICANCE OF MUCOSAL CRYPT PATTERN ON MUCOSAL NEOPLASTIC LESIONS OF LARGE INTESTINE

目的 :探讨内镜下的大肠黏膜腺管开口分型对大肠肿瘤性病变或非肿瘤性病变的诊断价值。方法 :2 0 0 1年 8月～ 2 0 0 2年 8月结肠镜检查 2 92 6例次 ,病变采用内镜下黏膜染色技术 ,部分病变结合放大内镜及实体显微镜观察腺管开口分型 (pit分型 )并与病理诊断对照 ,pit分型采用工藤分型。结果 :检出大肠隆起性病变共 6 0 8个 ,非肿瘤性病变 189个 ,占 31.1% ,其中增生性息肉 114个 (18.8% ) ,炎性息肉 5 6个 (9.2 % ) ,P -J息肉 4个 (0 .7% ) ,幼年性息肉 15个 (2 .5 % ) ;腺瘤性息肉 2 6 0个 ,占 4 2 .8% ;进展期癌 15 9例 (2 6 .2 % )。非肿瘤性息肉以Ⅰ、Ⅱ型腺管开口为主 ,占 95 .2 % (180 / 189) ;而在腺瘤性息肉中 ,Ⅱ、ⅢL、Ⅳ型腺管开口分别占2 6 .5 %、5 6 .9%、16 .5 % ,尤其是管状腺瘤 ,Ⅱ型腺管开口伴轻至中度不典型增生的百分率为 33.3% ,ⅢL 型腺管开口伴中至重度不典型增生者为 5 7.3% ,而Ⅳ型腺管开口伴中至重度不典型增生者为 71.4 % ;进展期癌均表现为黏膜腺管开口破坏无结构 ,为ⅤN 型。结论 :大肠腺管开口分型对于判断肿瘤性 ,非肿瘤性病变以及早期大肠癌并指导及时的内镜治疗或手术切除具有重要意义及临床实用价值。

Objective:To investigate the diagnostic value of mucosal crypt pattern by endoscope on mucosal neoplastic or non-neoplastic lesions of large intestine.Methods:We examined 2926 patients with colonoscopy and had the mucosal lesions stained with 0.2% indigo carmine, and part of them observed with magnifying endoscope and stereomicroscope, then compared the mucosal crypt patterns (the pit patterns set up by Kudo) with pathologic diagnosis.Results:There are 608 prominent lesions on the large intestine mucosa to be found, and among them there are 189(31.1%)non-neoplastic lesions and 260(42.8%) adenomatous polyps and 209(26.2%) developing period cancers. The pit pattern of the most non-neoplastic lesions is type Ⅰ or Ⅱ,which is about 95.2%(180/189),and among the adenomatous polyps the pit pattern of Ⅱ, ⅢL or Ⅳ is 26.5%, 56.9%, 16.5% respectively. Especially the tubular adenoma with mild to middle dysplasia of type Ⅱ crypt patterns is 33.3%, that with middle to severe dysplasia of type ⅢL patterns is 57.3%,and that with middle to severe dysplasia of type Ⅳ patterns is 71.4%. All the invasive carcinomas' pit patterns are type Ⅴ.Conclusions: It is very important and of clinical applied value to distinguish the pit patterns for determining the nature of mucosal lesions as neoplastic, non-neoplastic or earlier period carcinomas and indicating the treatment choice for the lesions removed endoscopically or by surgery.