| 郭利华,丁勇,胡柯峰,张新军,杨齐华,叶国良.137例不同类型结直肠侧向发育型肿瘤病理表现及内镜治疗分析[J].浙江中西医结合杂志,2022,32(11): |
| 137例不同类型结直肠侧向发育型肿瘤病理表现及内镜治疗分析 |
| Endoscopic therapy and pathological analysis of137 samples of different types of colorectal lateral spreading |
| 投稿时间：2021-12-16 修订日期：2022-09-22 |
| DOI： |
| 中文关键词: 结肠肿瘤 侧向发育型肿瘤 内镜形态 病理学 内镜下剥离术 |
| 英文关键词:colorectal neoplasms lateral spreading tumor endoscopic morphology pathology endoscopic submucosal dissection |
| 基金项目:宁波市重大科技任务攻关项目（No.2021Z133) |
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| 中文摘要: |
| 目的 探讨结直肠侧向发育型肿瘤(LST)内镜形态、病理特点及治疗效果等情况。方法 回顾性分析2017年1月－2020年1月宁波大学医学院附属医院内镜中心经内镜治疗137例LST病变的临床资料。将LST分成LST-G组及LST-NG组,分析组间病变部位、大小、内镜分型及病理分类的差异；比较组间整块切除率、完整切除率及治愈性切除率的差异,比较术后并发症发生情况的差异。结果 LST颗粒型(LST-G)发病率69.34%(95/137),非颗粒型(LST-NG)发病率30.66%(42/137)；LST结直肠各个部位均有分布,升结肠好发,发病率为 25.55%(35/137),结直肠各部位发病率LST-G组与LST-NG比较,差异无统计学意义(P>0.05)。病理类型方面,LST-G组与LST-NG管状腺瘤发病率最高,分别为70.53%(67/95)及66.67%(28/42)；锯齿状腺瘤发病率LST-NG组(26.19%,11/42)明显高于LST-G组(4.21%,4/95),差异有统计学意义(P<0.05)；LST-G组与LST-NG 组管状腺瘤、绒毛状腺瘤、管状绒毛状腺瘤、低级别上皮内瘤变(LGIN)、高级别上皮内瘤变(HGIN)以及癌变的概率相当,差异无统计学差异(P>0.05)。病理学检查示9例早期结直肠癌,癌变率(6.57%,9/137),4例(1例pT1b1脉管癌栓+3例pT1b2)追加外科手术,术后无癌组织残留及脉管浸润,术后3~6个月复查肠镜均未复发。LST-G与LST-NG之间整块切除率(91.58% vs 95.23%),完全切除率(86.32% vs 88.09%)和治愈性切除率(82.21% vs 85.71%)差异无统计学意义(P>0.05)。术后1例出现迟发性穿孔,转外科手术治疗,无迟发性出血发生。结论 对于符合适应症LST病灶首选ESD内镜治疗,术后病理为预后及进一步干预措施提供可靠证据。 |
| 英文摘要: |
| Objective To investigate the endoscopic morphology, pathological characteristics of colorectal lateral spreading tumor (LST) and explore the therapeutic effect of endoscopic treatment. Methods Clinical data of 137 cases of colorectal LST treated with endoscopy approach at the Endoscopy center, the Affiliated Hospital of Medical College of Ningbo University from January 2017 to January 2020 were retrospectively studied. The LST lesions were divided into LST-G group and LST-NG group. The pathologic features, lesion site and size, endoscopic morphology, the en bloc resection rate, complete resection rate and curative resection rate, as well as postoperative complication were retrospectively analyzed. Results The incidence rate of granular type lateral spreading tumor (LST-G) was 69.34% (94/137), while that of non-granular type lateral spreading tumor (LST-NG) was 30.66% (42/137). LST distributed to various parts of colon and rectum, ascending colon was one of the most frequent locations, and its incidence rate was 25.55% (35/137). There was no statistically significant difference in the incidence of different locations (P>0.05). The incidence of tubular adenoma was the highest, with 70.53% (67/95) of LST-G and 66.67% (28/42) of LST-NG, the incidence of serrated adenoma of LST-NG (26.19%, 11/42) was higher than LST-G (4.21%, 4/95), with a statistically significant difference (P < 0.05). LST-G and LST-NG had similar occurrences of tubular adenomas, villous adenomas, villous tubular adenomas, low grade intraepithelial neoplasia (LGIN), high-grade intraepithelial neoplasia (HGIN), and early colorectal carcinoma, respectively, with no statistically significant difference (P > 0.05). The pathological examination revealed that 9 lesions were early colorectal cancer with a canceration rate 6.57% (9/137), Additional surgery was performed in 4 cases (1 pT1b1with tumor emboli found in the vessels + 3 pT1b2) with pathological results suggesting no clear cancer residue, no tumor emboli within the vessels. There was no recurrence found under colonoscopy at a flow-up of 3-6 months after surgery. There was no significant difference between LST-G and LST-NG including en bloc resection rate (91.58% vs 95.23%), complete resection rate (86.32% vs 88.09%) and complete cure resection rate (82.21% vs 85.71%). Delayed perforation occurred in 1 patient, who was converted to surgery, and no postoperative delayed bleeding occurred. Conclusion ESD treatment is the first choice for LST lesions that meet indications for endoscopic therapy. Postoperative pathological analysis can provide reliable evidence for prognosis and further intervention. |
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