CAJ | 학술논문

目的探讨结直肠上皮内瘤变病理诊断的临床意义和外科治疗的原则.方法于2004年1月至2008年6月共收治术前经内镜活检、病理诊断为"上皮内瘤变"的病例共158例(共162个肿瘤),其中诊断为低级别上皮内瘤变73例,高级别上皮内瘤变89例.行腺瘤切除术5例,根治性结肠切除手术49例,直肠低位前切除术74例,经肛门局部切除术16例,Hartmann直肠经腹切除结肠造口术2例,腹会阴切除术4例,Parks结肠肛管吻合术7例,乙结肠造口术1例.经手术切除的标本常规作病理学检查,并与该患者的术前活检作比较,进行回顾性分析.结果术后109例(67.3%)病理证实为浸润性腺癌,在89例术前诊断为高级别上皮内瘤变的腺瘤中,80例(89.9%)术后病理确定是腺癌;在低级别上皮内瘤变中亦有29例(39.7%)术后确定为浸润性腺癌.在109例腺癌中2例伴有肝转移(MI),18例则有邻近组织浸润(T4).术后病理证实有局部淋巴结转移或见癌结节者26例(23.9%).结论应重视结直肠上皮内瘤变的病理诊断,高度警惕高级别上皮内瘤变.在临床和内镜中疑为恶性的病变,若不涉及保肛问题,宜首选作病变肠段切除,如术中可确诊为浸润性癌,则应作根治性切除.
목적 탐토결직장상피내류변병리진단적림상의의화외과치료적원칙.방법 우2004년1월지2008년6월공수치술전경내경활검、병리진단위"상피내류변"적병례공158례(공162개종류),기중진단위저급별상피내류변73례,고급별상피내류변89례.행선류절제술5례,근치성결장절제수술49례,직장저위전절제술74례,경항문국부절제술16례,Hartmann직장경복절제결장조구술2례,복회음절제술4례,Parks결장항관문합술7례,을결장조구술1례.경수술절제적표본상규작병이학검사,병여해환자적술전활검작비교,진행회고성분석.결과 술후109례(67.3%)병리증실위침윤성선암,재89례술전진단위고급별상피내류변적선류중,80례(89.9%)술후병리학정시선암;재저급별상피내류변중역유29례(39.7%)술후학정위침윤성선암.재109례선암중2례반유간전이(MI),18례칙유린근조직침윤(T4).술후병리증실유국부림파결전이혹견암결절자26례(23.9%).결론 응중시결직장상피내류변적병리진단,고도경척고급별상피내류변.재림상화내경중의위악성적병변,약불섭급보항문제,의수선작병변장단절제,여술중가학진위침윤성암,칙응작근치성절제.
Objective To discuss the significance of pathological diagnosis of colorectal intraepithelial neoplasia and its treatment principles. Methods One hundred and fifty-eight cases with colorectal tumors were treated between January 2004 and June 2008, among them 73 cases of tumors were diagnosed as low grade intraepithelial neoplasia and 89 tumors as high grade intraepithelial neoplasia on biopsy. Five patients with adenoma were treated with endoscopic polypectomy, 49 patients with radical colectomy, 74 patients with low anterior resection (LAB), 16 patients with local excision, 2 patients with Hartmann operation, 4 patients with abdominal perineal resection, 7 patients with Parks coloanal anastomosis and 1 patient with sigmoid colostomy. The postoperative pathological examination result was compared with preoperative biopsy examination. Results With postoperative pathological examination, 109 cases (67.3%) were identified as infiltrative adenocarcinoma, among them 80 cases (89.9%) had been diagnosed as high grade intraepithelial neoplasia and the other 29 cases (39. 7%) had been diagnosed as low grade intraepithelial neoplasia before the operation. In patients with infiltrative adenocarcinomas, 2 cases developed hepatic metastasis, 18 were classified as phase T4, and 26 cases (23. 9%) were found with lymph nodes metastasis after the operation. Conclusions We should pay more attention to tumors with a diagnosis of intraepithelial neoplasia due to its high potential of malignancy. When the lesion was highly suspected to be malignant, and the resection of the tumor would save the anal sphincter, the tumor should be treated with segmental resection. If the tumor could be confirmed as a infiltrating one then a curative resection is the first choice.