【摘要】 目的　回顾性分析南方医院近 2年内在肠镜检查中发现的 4 6例共 4 7个大肠侧向发育型肿瘤 (LST)病变的检出及处理情况。方法　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 ,4 6例LST患者中 ,4 2例共 4 2个病变接受内镜下治疗 ,其中 14例行注射法内镜下黏膜剥离切除术 (EMR)切除病变 ,2 4例行注射法内镜下黏膜剥离分片切除术 (EPMR)切除病变 ,1例行透明帽辅助EPMR切除病变 ,3例行单纯高频电热圈套切除术切除病变。结果　LST检出率 :常规肠镜检查中LST病变检出率为 0 8%。病变分布 :4 7个LST病变中 ,直肠 2 2个 ,乙状结肠 10个 ,降结肠 7个 ,横结肠 4个 ,升结肠 2个 ,盲肠 2个。内镜下病变大体分型 :颗粒均一型 2 5个 ,结节混合型 12个 ,平坦隆起型 8个 ,假凹陷型 2个。Pit形态 :Ⅱ型pit 2个 ,Ⅱ型 +ⅢL型pit8个 ,ⅢL型pit9个 ,IV型pit2 8个。病理形态 :绒毛状腺瘤 2 8例 ,均伴中度以上不典型增生 ,其中 7例有局部癌变 (6例m癌 ,1例sm1癌 ) ,但根部无癌残留 ;增生性息肉 2例 ;管状腺瘤 11例 ,10例合并中度不典型增生 ,1例局部癌变 (m癌 ) ;锯齿状腺瘤 (Serrated腺瘤 ) 6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 ,?更多还原

【Abstract】 Objective The laterally spreading tumor (LST) of the large intestine have received a great deal of study in Japan, but no report of such cases was found in China. We here of report 46 cases of LST (47 lesions, because one of the patients was found to have two lesions) diagnosed in our hospital in last two years. The morphological features under endoscopy, pit pattern, pathology and treatment under endoscopy were studied. Methods The 47 lesions of LST were found in a total of 5 735 patients who underwent colonoscopic examination in the last two years (from 01-12-2000 to 30-11-2002). The site, size and morphological features of LST were recorded, and the pit pattern was classified with magnification. 42 patients (totally 42 lesions) received colonoscopic surgery, and the rest refused to accept endoscopic therapy, therefore only a biopsy was done for pathological study. In those patients who accepted colonoscopic surgery, 14 patients were treated by mucosal resection (EMR) after injection of saline solution, 24 were treated by piecemeal mucosal resection (EPMR) after injection of saline solution, in 3 patients the lesion was removed by high frequency loop resection, and Cap-EMR was performed using distal hyaline hat attachment fitted to the end of endoscope. The resected or biopsy specimens were studied pathologically. Results 47 lesions of LST were found in a total of 5863 patients who underwent colonoscopic examination. The distrihution of LST lesions were as follows. 22 lesions were situated in the rectum, 10 lesions in the sigmoid colon, 7 lesions in the descending colon, 4 lesions in the transverse colon, 2 lesions in the ascending colon, and 2 lesions were located in the cecum. Macroscopic type: 25 lesions were homogeneous granular type, 12 lesions were mixed nodular granular type, 8 lesions were flat elevated type, and 2 lesions were pseudo-depressed type. The pit pattern as revealed under magnifying endoscopy indicated that 2 lesions were of type II pit, 8 lesion of type II+III L pit, 9 lesions of type III L pit, and 28 lesions of type IV. The pathological diagnosis revealed that 28 lesions were villous adenomas in which 7 lesions showed early malignant degeneration (6 intramucosal cancer and 1 submucosal cancer). 11 lesions were tubular adenomas, in which 1 was intramucosal cancer, 2 lesions were hyperplastic polyp, and 6 lesions were mixed hyperplastic polyps (serrated adenomas). Conclusion The LST manifest some special features, and their incidence may be higher in China than in Japan. EMR or EPMR may be considered as a good method for treatment for LST.更多还原