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目的大肠侧向发育型肿瘤(Laterally Spreading Tumor,LST)近年在日本有较多研究,我国目前尚未见有相关报道,本文总结了最近我院5个月内肠镜检查发现的13例LST病变,对其内镜下的形态特征,大体分型,肿瘤表面pit分型,病理形态及内镜下处理等进行了初步研究。方法 2000年12月1日至2001年4月30日共行肠镜检查857例,检出LST病变13例共14处病灶,记录所有LST病变的部位、大小、形态特征及内镜下大体分型,所有病例均行放大内镜观察病变表面的pit形态,13例LST患者中,12例共12个病变接受内镜下治疗,另1例患者拒绝内镜下治疗,仅行活检。接受内镜治疗患者中,4例行注射法粘膜切除术(EMR)切除病变,4例行注射法粘膜分片切除术(EPMR)切除病变,1例行透明帽辅助粘膜分片切除术(EPMR)切除病变,3例行单纯PSD术切除病变。所有内镜下治疗均获得成功,无并发症发生。切除及活检标本行常规病理学检查。结果 LST检出率:常规肠镜检查中LST病变检出率为1.52％。病变分布:14个LST病变中,直肠6个,乙状结肠2个,横结肠2个,升结肠4个。内镜下病变大体分型:颗粒均一型5个,结节混合型6个,平坦隆起型3个,假凹陷型0个。Pit形态:Ⅱ型pit1例,Ⅱ型+Ⅲ_L型3个,Ⅲ_L型pit3个,Ⅳ型pit7个。病理形态:绒毛状腺瘤6例,均伴中度以上不典型增生,其中2例有局部癌变(m癌),但根部无癌残留。增生性息肉2例,管状绒毛状腺瘤3例,均合并中度不典型增生。混合型腺瘤(Serrated腺瘤)2例。结论大肠LST病变在我国有较高的检出率,其内镜形态具有一定特殊性,处理方法可采用内镜下粘膜切除术。
Objective Lateral Spreading Tumor (LST) has been studied in Japan in recent years. There are no reports in China yet. This article summarizes the 13 cases of LST lesions found in the recent 5 years of colonoscopy in our hospital. The morphological features, general classification, pit classification on the tumor surface, pathological morphology and endoscopic treatment were studied preliminarily. Methods From December 1, 2000 to April 30, 2001, a total of 857 cases were examined by colonoscopy. 13 lesions of 13 cases of LST lesions were detected. The location, size, morphological characteristics, and endoscopic scores of all LST lesions were recorded. All patients underwent magnifying endoscopy to observe pit morphology on the lesion surface. Of the 13 patients with LST, 12 of 12 patients underwent endoscopic treatment, and the other patient refused endoscopic treatment and only underwent biopsy. Of the patients who received endoscopic therapy, 4 underwent resection of mucosal resection (EMR), 4 underwent mucosal resection (EPMR) to remove lesions, and 1 underwent transparent cap assisted mucosal resection (EPMR). ) Excision of lesions, 3 cases of simple PSD resection of lesions. All endoscopic treatments were successful without complications. Resection and biopsy specimens were routinely pathologically examined. Results LST detection rate: The detection rate of LST lesion in routine colonoscopy was 1.52%. Lesion distribution: 14 LST lesions, 6 rectums, 2 sigmoid colons, 2 transverse colons, and 4 ascending colons. Endoscopic lesions were roughly classified: 5 uniform particles, 6 mixed nodules, 3 flat bulges, and 0 false dents. Pit morphology: 1 case of type II pit, 3 type II type III_L, 3 type III_L pit, and 7 type IV pit. Pathological morphology: villous adenoma in 6 cases, both with moderate or above atypical hyperplasia, of which 2 cases had local cancer (m cancer), but no root cancer residue. There were 2 cases of hyperplastic polyps and 3 cases of tubular villous adenomas, all with moderate dysplasia. Mixed adenoma (Serrated adenoma) in 2 cases. Conclusion The LST lesions in the large intestine have a high detection rate in our country. The endoscopic morphology has a certain degree of specificity. The treatment method can be used under the endoscopic mucosal resection.