结肠镜活组织检查在结直肠高级别上皮内瘤变诊断中的应用研究

目的研究结肠镜活组织检查在结直肠高级别上皮内瘤变(HGIN)诊断中的应用价值。方法选取2019年1月至2020年12月本院收治的有结直肠肿瘤特征患者400例纳入研究,所有患者均行术前结肠镜活检,并行术后切除病理标本检查。比较两种方法对HGIN的诊断效能。结果50例HGIN患者接受全瘤切除活检13例(26.00%),其中内镜下切除术10例,经肛切除术3例;根治性切除术37例(74.00%)。13例全瘤切除活检患者术后病理诊断显示HGIN 9例,浸润性癌4例;37例根治性切除术患者术后病理诊断显示HGIN 20例,浸润性癌4例。结论结肠镜活组织检查对HGIN具有很高的诊断价值,临床工作中应当根据其病变大小、部位、分化程度慎重并及时处理,确保患者临床治疗效果。

经结肠镜活组织检查诊断为结直肠高级别上皮内瘤变76例的临床分析

目的分析结肠镜活组织检查诊断为结直肠高级别上皮内瘤变（HGIN）患者的内镜下表现、CT检查特点与术后病理类型的关系。方法纳入2009年10月至2015年10月经结肠镜活组织检查诊断为结直肠HGIN，并行内镜下切除或手术治疗，且有完整术后病理资料的患者。分析患者的术前CT检查结果、术后病理类型、病变最长径、广基或有蒂病变、淋巴结增大等情况。统计学分析采用卡方检验，并计算术前CT检查对发现结直肠浸润癌的敏感度和特异度。结果76例患者中，术后经病理证实，HGIN占21.1%（16/76），浸润癌占78.9%（60/76）。年龄≤50岁组的浸润癌发生率（3/14）低于〉50岁组[91.9%（57/62）]，差异有统计学意义（χ^2＝30.05，P〈0.01）。隆起型病变最长径≥3.0 cm组的浸润癌发生率[98.3%（57/58）]高于最长径〈3.0 cm组（2/16），差异有统计学意义（χ^2＝51.91，P〈0.01）。有蒂息肉组的浸润癌发生率（2/13）低于无蒂隆起组[93.4%（57/61）]，差异有统计学意义（χ^2＝35.72，P〈0.01）。术前CT检查诊断结直肠浸润癌的敏感度为95.0%，特异度为84.6%。CT检查发现局部淋巴结增大组的浸润癌发生率为93.3%（42/45），高于未发现淋巴结增大组的64.3%（18/28），差异有统计学意义（χ^2＝9.95，P＝0.002）。结论CT检查可弥补结肠镜活组织检查将部分浸润癌诊断为HGIN的不足。年龄〉50岁、最长径大、病变无蒂、CT检查示结直肠占位和局部淋巴结增大者的浸润癌发生率高。

Magnifying colonoscopy as a non-biopsy technique for differential diagnosis of non-neoplastic and neoplastic lesions

AIM： To clarify whether mucosal crypt patterns observed with magnifying colonoscopy are feasible to distinguish non-neoplastic polyps from neoplastic polyps. METHODS： From June 1999 through March 2000, 180 consecutive patients with 210 lesions diagnosed with a magnifying colonoscope （CF-200Z, Olympus Optical Co., Ltd., Tokyo, Japan） were enrolled. Magnification and chromoendoscopy with 0.2% indigo-carmine dye was applied to each lesion for mucosal crypt observation. Lesions showing types Ⅰ and Ⅱ crypt patterns were considered non-neoplastic and examined histologically by biopsy, whereas lesions showing types Ⅲ to Ⅴ crypt patterns were removed endoscopically or surgically. The correlation of endoscopic diagnosis and histologic diagnosis was then investigated. RESULTS： At endoscopy, 24 lesions showed a type Ⅰ or Ⅱ pit pattern, and 186 lesions showed type Ⅲ to Ⅴ pit patterns. With histologic examination, 26 lesions were diagnosed as non-neoplastic polyps, and 184 lesions were diagnosed as neoplastic polyps. The overall diagnostic accuracy was 99.1% （208/210）. The sensitivity and specificity were 92.3% （24/26） and 99.8% （184/186）, respectively. CONCLUSION： Magnifying colonoscopy could be used as a non-biopsy technique for differentiating neoplastic and non-neoplastic polyps.