本文選題：大腸側(cè)向發(fā)育型腫瘤 + 形態(tài)特點(diǎn)��； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:側(cè)向發(fā)育型腫瘤(laterally spreading tumors,LST)特指一類(lèi)直徑大于10mm的平坦型病變,其延腸壁橫向生長(zhǎng)而非垂直性生長(zhǎng),與結(jié)直腸癌關(guān)系密切,且容易發(fā)生粘膜下浸潤(rùn)。LST在結(jié)腸鏡檢查時(shí)容易漏診,且鏡下微創(chuàng)治療技術(shù)要求高,易導(dǎo)致不完全切除和局部復(fù)發(fā),因此LST的內(nèi)鏡下診斷及治療對(duì)于結(jié)直腸癌的預(yù)防很重要。本文研究探討LST的鏡下特點(diǎn)和治療,為提高LST檢出率和進(jìn)一步治療方案的選擇提供參考依據(jù)。方法:回顧性研究陸軍總醫(yī)院消化內(nèi)鏡中心2010年3月-2016年5月經(jīng)結(jié)腸鏡檢查發(fā)現(xiàn)的LST,分析其大體形態(tài)、表面隱窩開(kāi)口、NBI下特征與病理組織學(xué)之間的關(guān)系,以及不同治療方法和內(nèi)鏡隨訪(fǎng)結(jié)果。結(jié)果:1.共發(fā)現(xiàn)LST型息肉615處(551例患者),占同期檢出息肉的2.17%,病灶平均直徑22.2±14.7mm。其中大小在10-20mm的LST占比最高(66.5%),多見(jiàn)于近端結(jié)腸(55.4%),大體形態(tài)分型以平坦隆起型(LST-NGF)最多見(jiàn)(占22.76%)。LST中黏膜下癌為3.25%(20/615)。4種亞分類(lèi)中LST-NGPD發(fā)生黏膜下癌比率最高:14.29%(12/84)。直腸的LST相比于結(jié)腸的LST直徑更大(31.49±23.09 vs 20.82±9.86,p0.05),且發(fā)生早癌的概率更高(36.43%vs 14.95%,p0.001)。2.側(cè)向發(fā)育型腫瘤的腺管開(kāi)口以IIIL型(30.56%)、IV型(32.94%)最多見(jiàn)。預(yù)示癌的V型pit pattern在LST-GM與LST-NGPD中占相對(duì)較多的比例,分別為29.11%、41.93%。所有的黏膜下癌均表現(xiàn)為V型pit pattern,其中VN型pit pattern預(yù)測(cè)黏膜下癌的準(zhǔn)確率為58.33%。有4.19%的NICE2型病灶和55.56%的NICE3型病灶為黏膜下癌。3.在615例LST病灶中,343例(55.77%)行內(nèi)鏡下黏膜剝離術(shù)(EMR)或者precutting-EMR,29例(4.72%)行內(nèi)鏡下分片黏膜切除術(shù)(EPMR)治療;228例(37.07%)行內(nèi)鏡黏膜下剝離術(shù)(ESD),包括外科手術(shù)等其他治療方式15例.完整切除率(CR)94.80%。其中經(jīng)ESD治療發(fā)生術(shù)中出血共56例(24.57%),延遲性出血1例(4.39%),穿孔12例(5.26%)。經(jīng)內(nèi)鏡下治療(EMR、precutting-EMR與ESD)術(shù)后病理提示切緣陽(yáng)性的占4.90%(28/571)。治療后可隨訪(fǎng)到患者330例,隨訪(fǎng)時(shí)間中位數(shù)為15個(gè)月。共有10例復(fù)發(fā),其中內(nèi)鏡下分片EPMR復(fù)發(fā)率較高為13.79%(4/29),EMR復(fù)發(fā)率為1.32%(2/152),相比近3年經(jīng)ESD治療的LST均無(wú)復(fù)發(fā)。結(jié)論:側(cè)向發(fā)育型腫瘤以近端結(jié)腸為主,4種亞分類(lèi)中LST-NGPD發(fā)生黏膜下癌比率最高。直腸的LST相比于結(jié)腸的LST直徑更大,且發(fā)生早癌的概率更高。V型腺管和NICE3型病灶提示黏膜下癌可能性大。對(duì)于直徑較大LST,分片切除病灶復(fù)發(fā)率大,完整的內(nèi)鏡粘膜下剝離術(shù)(ESD)為其安全有效的治療方式。
[Abstract]:Objective: lateral spreading tumors (LST) refer to a class of flat lesions whose diameter is larger than 10mm. The transverse rather than vertical growth of the tubule wall is closely related to colorectal cancer. Submucous infiltration. LST is easy to be missed in colonoscopy, and the technique of minimally invasive treatment is high, which can lead to incomplete resection and local recurrence. Therefore, endoscopic diagnosis and treatment of LST is very important for the prevention of colorectal cancer. In this paper, the characteristics and treatment of LST under microscope are studied, which provides a reference for improving the detection rate of LST and the choice of further treatment scheme. Methods: the LSTs from March 2010 to May 2016 in the Center of Digestive Endoscopy, General Hospital of the Army were retrospectively studied, and the relationship between the gross morphology, the features of NBI and the histopathology were analyzed. As well as different treatment methods and endoscopic follow-up results. The result is 1: 1. A total of 551 patients with 615 LST polyps were found, accounting for 2.17% of the polyps detected in the same period. The mean diameter of the lesions was 22.2 鹵14.7 mm. The proportion of LST in 10-20mm was the highest (66.5%), and it was more common in the proximal colon (55.4%). The most common type was flat protuberant LST-NGF (3.25% 20% 615.4% of submucosal carcinoma in 22.76%).LST). LST-NGPD had the highest incidence of submucosal cancer in 30% 14.2912% 84%. The LST of the rectum was 31.49 鹵23.09 in diameter and 20.82 鹵9.86 in the colon, and had a higher incidence of early cancer than that of the colon, 36.43 vs 14.95. The most common adenoductal openings in lateral developmental tumors were IIIL type 30.56C and type IV (n = 32.94). The proportion of V-type pit pattern in LST-GM and LST-NGPD was 29.11% and 41.93%, respectively. All submucosal carcinomas showed V-type pit pattern.The accuracy of VN-type pit pattern in predicting submucosal carcinoma was 58.33. 4.19% of NICE2 lesions and 55.56% of NICE3 lesions were submucosal carcinomas. Of the 615 cases of LST lesions, 343 cases (55.77) were treated with endoscopic mucosal dissection (EMRs) or 29 cases with precutting-EMRA (4.72%) were treated by endoscopic submucosal excision (EMD), 15 cases were treated with endoscopic submucosal dissection (15 cases). The complete excision rate was 94. 80%. There were 56 cases of intraoperative hemorrhage in ESD, 1 case of delayed hemorrhage, and 12 cases of perforation. After endoscopic treatment of EMR-precutting-EMR and ESD, the positive rate of incisal margin was 4.90% or 28 / 571%. 330 patients were followed up after treatment, the median follow-up time was 15 months. There were 10 cases of recurrence, of which the higher recurrence rate of endoscopic EPMR was 13.79% and the recurrence rate of EMR was 1.32% / 152%. Compared with LST treated with ESD in recent 3 years, there was no recurrence. Conclusion: the submucosal carcinoma rate of LST-NGPD is the highest among the four subclassifications of lateral developing tumors. LST in the rectum is larger in diameter than in the colon and is more likely to develop early cancer. Type V adenoducts and NICE3 lesions suggest that submucosal cancer is more likely. For the larger LST, the recurrence rate of the lesion was high. The complete endoscopic submucosal dissection (ESD) was a safe and effective treatment for LST.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R735.34

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相關(guān)期刊論文 前2條

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