【摘要】 目的 探讨结直肠活检高级别上皮内瘤变的外科治疗原则及策略。方法 回顾性分析术前经肠镜活检病理诊断为高级别上皮内瘤变者25例,男性12例,女性13例;年龄40~77岁,平均年龄61.7岁;行右半结肠癌根治性切除10例,左半结肠癌根治性切除1例,左半结肠癌姑息性切除+横结肠造瘘1例,乙状结肠癌根治性切除4例,直肠癌根治性切除8例其中5例行Dixon,3例行Miles;1例直肠癌无法切除行乙状结肠造瘘术。结果 术后病理结果证实均为腺癌,其中高分化腺癌5例,中分化腺癌14例,低分化腺癌4例,黏液腺癌2例;侵及黏膜下层2例,肌层5例,全层18例;早癌2例占8%,中晚期癌23例占92%。结论 临床医师对于结直肠活检为高级别上皮内瘤变者,应高度重视,积极行外科处理,对于直肠上端肿瘤及结肠肿瘤,可不必行多次活检,只要镜下所见为“癌”了,可直接手术。但是对于中低位直肠肿瘤因涉及保肛问题,应行多次活检确诊后再手术,若多次活检仍不能确诊,可以在做好根治术的前提下,行经肛局部切除后,据冰冻切片检查结果决定手术方式。更多还原

【Abstract】 Objective To explore the principles and strategies of the surgical treatment of highgrade intraepithelial neoplasia(HGIN) diagnosed by colorectal biopsy.Methods Retrospective analysis of HGIN was performed on 25 patients(12 males and 13 females;aged 40-77 years,mean age 61.7 years) diagnosed by colonoscopy biopsy preoperatively.Ten patients received right colon cancer radical resection,1 received left colon cancer radical resection,1 received palliative resection of the left colon cancer plus transverse colon colostomy,4 received sigmoid colon cancer radical resection,8 received rectal cancer resection(5 had routine Dixon and 3 had routine Miles),and 1 received sigmoid colostomy because of unresectable rectal cancer.Results Postoperative pathological results confirmed adenocarcinoma in all cases including 5 cases of highly differentiated adenocarcinoma,14 cases of moderately differentiated adenocarcinoma,4 cases of poorly differentiated adenocarcinoma,and 2 cases of mucinous adenocarcinoma.Colorectal biopsies showed that 2 cases had submucosal invasion,5 cases had muscularis propria invasion and 18 cases had full-thickness invasion.8%(2/25) of the patients had early-stage cancer and 92%(23/25) had advanced cancer.Conclusion Clinicians should realize the importance and value of colorectal biopsy for HGIN.Surgical treatment for cancers at the rectal upper end or colon should be performed immediately as long as the endoscopic findings reveal positive "cancer" without waiting for a number of biopsies.However,multiple biopsies should be performed before surgery for low rectal tumors because of the consideration to preserve the anal sphincter.If multiple biopsies still can’t confirm the diagnosis,radical surgery or other surgical treatments should be determined based on examination results from frozen section of the transanal local excision of the tumor.更多还原