【作者】 张立玮； 王鼎鑫； 于卫芳； 郭晓青； 高扬； 徐志彬； 王顺平； 李英赛； 尔立棉； 吴明利； 王士杰；

【Author】 Zhang Li-Wei Wang Ding-Xin Yu Wei-Fang Guo Xiao-Qing Gao Yang Xu Zhi-Bin Wang Shun-Ping Li Ying-Sai Er Li-Mian Wu Ming-Li Wang Shi-Jie Department of Endoscopy, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011

【机构】 河北医科大学第四医院暨河北省肿瘤医院内镜室；

【摘要】 目的:应用放大色素肠镜观察大肠肿瘤性病变粘膜腺管开口类型并与病理组织学诊断对照,以研究放大色素肠镜诊断肿瘤性病变的特异性和敏感性,探讨大肠病变腺管开口类型与病理组织学关系。并在放大色素肠镜判定腺管开口类型的基础上,结合扫描电镜显示其相应超微结构特征,为肿瘤发展演变机理的研究提供形态学依据。方法:采用放大色素肠镜检查586例患者,发现大肠病变247个,以Kudo标准根据腺管开口结构进行分型,内镜直视下指导活检取材送检。1．用放大色素肠镜观察247处病灶粘膜腺管开口形态, 按Kudo分型作病灶性质判断,并与内镜活检病理组织学诊断相比较。2．放大色素肠镜下留取各型腺管开口标本行扫描电镜观察。结果:1．根据kudo分类标准,I、Ⅱ型腺管开口判断为非瘤性病变,ⅢL、ⅢS和Ⅳ型腺管开口为瘤性病变,V 型腺管开口常为癌。2．在247处病灶中,放大色素肠镜诊断瘤性病变的敏感性为96．2％,特异性为90．2％,非瘤性病变为 88．7％及95．6%,总准确率为92．6％。3．扫描电镜的低倍镜观察腺管开口与放大肠镜下所见图像相吻合,随着腺管类型的变化(I→V型),腺管开口逐渐延长和不整,腺管开口形态从较规则的圆形椭圆形到管状、脑回状直至不规则状甚至结构消失。结论:放大色素肠镜对肿瘤性病变腺管开口类型的判定与病理组织学诊断符合率为92．6％,诊断瘤性病变敏感性高于特异性,诊断非瘤性病变的特异性高于敏感性,即不易漏诊瘤性病变,也不易将瘤性病变误诊为非瘤性病变。通过对腺管开口形态的观察指导活检,有助于提高病变诊断的准确性。应用放大色素肠镜技术可提高对表浅型病变的识别和侧向发育型肿瘤的检出。扫描电镜大大延伸了内镜的视野, 清晰地显示从正常到癌各个过渡阶段的腺管开口超微结构, 对印证腺管开口变化形成机理具有实用价值。更多还原

【Abstract】 Objective: To estimate the specificity and sensitivity for diagnosing lesions of large intestine with magnifying chromoendoscopy according to pit pattern classification as proposed by Kudo in comparison with histology, and to provide morphologic proofs for tumor progresses in microstructure observed by SEM on the basis of pit patterns of various lesions of large intestine. Methods: Once the lesions were detected by magnifying chromoendoscopy, observed the shape of the pit pattern based on Kudo standard of classification,and compared with histologic diagnosis. The specimens including various pit patterns were observed by SEM. Results: According Kudo standard of classification, type I, II were judged as non-neoplastic lesions,type III L ,III S and IV were judged as neoplasic lesions, and type V was judged as carcinoma. The sensitivity and specificity of magnifying endoscopy compared with histological diagnosis of neoplastic lesions were 96.2% and 90.2%, which of non-neoplastic lesions were 88.7% and 95.6%, the total accuracy was 92.6% in 247 cases lesions. The pit patterns were identical under lower lens of SEM , From type I to V, the pit patterns extended gradually: form regular round ,elliptic to tubular, branched, gy-rus-like, till irregular arrangement even non-structural. Conclusion: Magnifying chromoendoscopy has high efficacy in judging the nature of lesions,and has enabled us to distinguish between neoplasic or non-neoplastic. It is valuable in dectection and diagnosis of lesions of large intestine. SEM extended the visual field of endoscopy by linking organically with magnifying chromoendoscopy. SEM displayed the ultramicroscopic structures of various lesions of large intestine clearly from normal epithelium to carcinoma.更多还原