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目的:研究结直肠高级别上皮内瘤变的临床及病理特征,探讨外科治疗原则和策略。方法对病理诊断为高级别上皮内瘤变的44例患者进行术前病理与术后病理对比、分析,总结其临床意义。结果术后病理仅1例(2.27%)仍为高级别皮内瘤变,其余均证实为腺癌。其中2例伴有肝转移,1例肠系膜种植转移,26例已有局部淋巴结转移。Kappa值为0.286,术前术后差异较大。结论诊断为结直肠高级别上皮内瘤变的肿瘤绝大多数(97.72%)已存在癌变,部分已有局部淋巴结转移及远处转移,故应予积极的外科处理。结直肠肿瘤大于3cm者推荐行根治性手术,但对于低位直肠肿瘤应当多次内镜活检或者扩肛活检后再决定治疗方案。
Objective: To study the clinical and pathological features of high-grade intraepithelial neoplasia of colorectum and discuss the principles and strategies of surgical treatment. Methods Forty-four patients with high-grade intraepithelial neoplasia diagnosed by pathology were compared with preoperative pathology and postoperative pathology, and the clinical significance was analyzed. Results Postoperative pathology was only one case (2.27%) was still high grade intraepithelial neoplasia, the rest were confirmed as adenocarcinoma. Two cases were associated with liver metastases, one case mesenteric metastasis, 26 cases had local lymph node metastasis. The Kappa value was 0.286, which was significantly different before and after surgery. Conclusions Most of the tumors diagnosed as high-grade intraepithelial neoplasia of colorectal cancer (97.72%) are already cancerous, some have local lymph node metastasis and distant metastasis, so they should be actively surgically treated. Colorectal tumors greater than 3cm recommended radical surgery, but for low rectal tumors should be repeated biopsy or endoscopic biopsy after deciding the treatment options.