【摘要】 目的大肠侧向发育型肿瘤(LST)与大肠癌关系密切,其诊治不同于一般的隆起样肿瘤,文章总结LST内镜诊断与治疗的经验,以引起临床上对这个特殊类型肿瘤的重视。方法内镜检查发现肠道黏膜发红或粗糙、血管网不清或消失等病变,行靛胭脂染色后放大内镜观察其腺管开口类型。结果18个月中共发现34例LST 35个病变。其中黏膜内癌4例,锯齿状肿瘤2例。35个病变内镜分型颗粒均一型15个,结节混合型18个,假凹陷型2个。病变最大为68 mm×85 mm;11～20mm 8个,21～30 mm 13个,30 mm以上14个。大肠黏膜腺管开口类型ⅢL型10个,其中8个为管状绒毛状腺瘤;Ⅳ型22个,其中16个为绒毛状腺瘤,1个黏膜内癌;ⅤA型3个,均为黏膜内癌。35个病变全部即时或择期进行内镜下切除治疗,发生出血和局限性腹膜炎各1例。结论应用黏膜染色技术和放大内镜有助于LST的诊断。LST的腺管开口大多数表现为Ⅳ型或ⅢL型,ⅢL型腺管开口多为管状腺瘤,Ⅳ型腺管开口多为绒毛状腺瘤,一旦出现Ⅴ型腺管开口则表明已经有癌变发生。更多还原

【Abstract】 Objective Laterally spreading tumor (LST) has a close relationship with colorectal cancer, its diagnosis and treatment are differed from those of ordinary protuded tumors. The aim of this study is to attract much attention to this particular tumor. Methods Four thousand two hundred and ten patients were examined with magnifying endoscope and mucosa staining from December, first 2000 to May 31 , 2002. Results In 34 patients with LST, there were 35 lesions, including granular type 15, nodular - mixed type 18, and pseudocaved 2; and there were 4 patients with intramucosa carcinoma and other 2 with serrated adenoma. The biggest lesion is 68 mm × 85 mm, and the smallest 11 mm× 12 mm. Of the 35 lesions the diameters are 8 within 11 -20 mm, 13, 21 -30 mm and 14 above 31mm. The pit patterns of the 35 lesions are mainly IV pit patterns, about 62. 9% (22/35). The pathological diagnoses of 3 patients with VA pit patterns LST are intramucosa carcinoma, and 8 patients with Ⅲ L pit patterns are tubulovillous adenoma. All of the 35 lesions are resected by EMR or EPMR. Complication occurred in two patients during treatment of EMR such as hemorrhage and local peritonitis. Conclusion Mucosa staining and magnifying endoscopy is very useful in detecting LST. We must pay more attention to those signs, such as reddish and eneven mucosa or unclear or interrupted vascular network. Furthermore it is necessary to stain the mucosa with indigo carmine spray to get the evidences of flat tumor. Pit patterns of LST mostly are IV or ⅢL, and LST with Ⅳ pit patterns are mainly villous adenoma, ⅢL tubular adenoma, while LST with the Ⅴ pit pattern signifies the cancerated metaplasia.更多还原