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目的探讨大肠侧向发育型肿瘤(LST)临床病理特征及内镜下黏膜切除术的有效性、安全性。方法经普通内镜检查发现LST 119例,染色后观察病灶大小及部位并进行形态分型,再结合放大内镜确定腺管开口类型。有治疗适应证者行内镜下黏膜切除术,切除病灶黏膜送病理检查。结果 28个月中共发现119例LST 124个病变。内镜下分型:颗粒均一型44个,结节混合型48个,平坦隆起型23个,假凹陷型9个。病变直径:10～20 mm 65个,21～30 mm 23个,31 mm以上36个,最大病变110 mm×100 mm。病变部位:直肠50个,乙状结肠25个,降结肠11个,横结肠10个,升结肠+盲肠28个。黏膜腺管开口类型:Ⅲ型30个,其中17个为管状绒毛状腺瘤,12个为管状腺瘤;Ⅳ型56个,其中30个为绒毛状腺瘤,4个为黏膜内癌;Ⅴ型5个,其中2个为黏膜内癌,2个累及黏膜下层下1/3以下;Ⅱ型7个,其中5个为炎性增生性息肉,2个为锯齿状腺瘤(腺瘤性增生性息肉):其余为ⅢL+V型,其中23个为管状绒毛状腺瘤。符合适应证95例98个病变择期进行内镜下黏膜切除治疗,发生出血11例,均在操作过程中,无肠穿孔发生。结论大肠LST内镜形态具有一定特殊性,内镜下黏膜切除术是治疗在大肠的有效而安全的方法,可达到根治目的 。
Objective To investigate the clinicopathological characteristics of colorectal lateral growth tumor (LST) and the efficacy and safety of endoscopic mucosal resection. Methods 119 cases of LST were found by ordinary endoscopy. The size and location of the lesion were observed after the staining, and the morphological classification was performed. Combined with magnifying endoscopy to determine the type of duct opening. There are indications for treatment of endoscopic mucosal resection, remove the lesion mucosa sent to pathological examination. Results A total of 119 LST 124 lesions were found in 28 months. Endoscopic typing: uniform particles 44, nodular mixed 48, flat raised 23, false depression 9. Lesions diameter: 10 ~ 20 mm 65, 21 ~ 30 mm 23, 31 mm above 36, the largest lesion 110 mm × 100 mm. Lesions: rectal 50, 25 sigmoid colon, descending colon 11, transverse colon 10, ascending colon + cecum 28. Mucosal duct opening type: 30 type Ⅲ, of which 17 were tubular villous adenoma, 12 tubular adenoma; type Ⅳ 56, of which 30 were villous adenoma, 4 for intramucosal carcinoma; Ⅴ Type 5, of which 2 were intramucosal carcinoma, 2 below the submucosa under 1/3; type Ⅱ 7, of which 5 were inflammatory hyperplastic polyps, two serrated adenomas (adenomatous hyperplasia Polyp): the rest is Ⅲ L + V type, of which 23 are tubular villous adenoma. In line with indications 95 cases of 98 lesions elective endoscopic mucosal resection treatment, bleeding occurred in 11 cases, were in operation, no intestinal perforation. Conclusion The endoscopic morphology of the large intestine LST has some particularities. Endoscopic mucosal resection is an effective and safe method for the treatment of large intestine and can achieve the goal of radicalization.