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目的 探讨大肠息肉表面结构形态与病理组织学的关系,以提高对大肠息肉的实时诊断及治疗水平。方法对105例大肠息肉进行靛胭脂染色,放大内镜观察其表面结构形态,并参照Kudo法进行分类:Ⅰ、Ⅱ型为非瘤性息肉,ⅢL、ⅢS、Ⅳ及混合型为腺瘤性息肉,Ⅴ型为癌变,比较息肉表面结构与大体形态及病理之间的关系。结果17例有蒂息肉中12例表现为Ⅰ、Ⅱ型;40例亚蒂息肉和48例广基息肉中Ⅰ、Ⅱ型分别为15.0％(6/40)和41.7％(20/48),ⅢL、ⅢS、Ⅳ、Ⅴ、混合型合计为85.0％(34/40)和58.3％(28/48)。83.8％(88例)的息肉位于直肠至脾曲结肠,息肉表型与其发生部位无关。炎性及增生性息肉中非瘤性表型为78.6％,瘤性表型为21.4％;腺瘤息肉中非瘤性表型为3.3％,瘤性表型为96.7％;幼年性息肉均为非瘤性表型。Ⅰ、Ⅱ、ⅢL、ⅢS、Ⅳ、Ⅴ及混合型息肉中腺瘤发生率分别为0％、11.8％、77.3％、75.0％、100.0％、100.0％和70.0％。分型诊断瘤性和非瘤性息肉的敏感性为96.7％和80.0％,特异性为86.6％和94.7％,鉴别诊断准确率为89.5％。结论用染色放大内镜分析大肠息肉表面结构,能有效鉴别大肠非瘤性息肉、腺瘤和癌,有助于在结肠镜检查的同时决定对病灶的处理。
Objective To investigate the relationship between the morphology and histopathology of colorectal polyps to improve the real-time diagnosis and treatment of colorectal polyps. Methods 105 cases of colorectal polyps were stained with indigo. The surface structure of the polyps were observed by magnifying endoscopy and classified according to Kudo’s method. Type Ⅰ and Ⅱ were non-tumorous polyps, ⅢL, ⅢS and Ⅳ were mixed adenomatous polyps , Ⅴ type of cancer, the polyp surface structure and the relationship between the general morphology and pathology. Results In the 17 cases of pedunculated polyps, 12 cases showed type Ⅰ and Ⅱ. The percentage of type Ⅰ and type Ⅱ was 15.0% (6/40) and 41.7% (20/48) in 40 cases of polyps and 48 cases of polyps. The total of ⅢL, ⅢS, Ⅳ, Ⅴ and mixed type were 85.0% (34/40) and 58.3% (28/48). 83.8% (88 cases) of the polyps located in the rectum to the spleen of the colon, polyps phenotype and its place has nothing to do. In the inflammatory and proliferative polyps, the non-neoplastic phenotype was 78.6% and the neoplastic neoplastic phenotype was 21.4%. The non-neoplastic phenotype in adenoma polyps was 3.3% and the neoplastic phenotype was 96.7%. The juvenile polyps were Non-neoplastic phenotype. The incidences of adenomas in Ⅰ, Ⅱ, ⅢL, ⅢS, Ⅳ, Ⅴ and mixed polyps were 0%, 11.8%, 77.3%, 75.0%, 100.0%, 100.0% and 70.0%, respectively. The diagnostic sensitivity of tumor type and non-tumor polyp was 96.7% and 80.0% respectively, the specificity was 86.6% and 94.7%, and the differential diagnosis accuracy was 89.5%. Conclusions Using the magnifying endoscopy to analyze the surface structure of colorectal polyps, it can effectively identify non-tumorous colorectal polyps, adenomas and carcinomas, and help determine the treatment of lesions at the same time of colonoscopy.