胃肠病学
胃腸病學
위장병학
CHINESE JOURNAL OF GASTROENTEROLOGY
2014年
8期
476-481
,共6页
结直肠肿瘤%病理学%结直肠外科手术%内镜切除%治疗
結直腸腫瘤%病理學%結直腸外科手術%內鏡切除%治療
결직장종류%병이학%결직장외과수술%내경절제%치료
Colorectal Neoplasms%Pathology%Colorectal Surgery%Endoscopic Resection%Therapy
背景：早期结直肠癌因淋巴结转移率低而预后良好，如何提高其检出率并选择合理的治疗方式是亟待解决的临床问题。目的：分析早期结直肠癌在内镜切除或手术后的病理特点，评价内镜切除的疗效。方法：回顾性分析503例接受内镜切除或外科手术的早期结直肠癌病灶的病理资料，分析影响早期结直肠癌浸润深度、淋巴结转移的危险因素，并评价内镜切除的疗效。结果：早期结直肠癌的检出率为10.7%，淋巴结总转移率为1.2%（6/503），其中黏膜高级别瘤变的淋巴结转移率为0%（0/247），黏膜下层癌为2.3%（6/256）；内镜切除组黏膜下浅层癌的淋巴结转移率为0%（0/31）。肿瘤位置、肿瘤直径、组织学分型和淋巴结转移对早期结直肠癌的浸润深度有显著影响（P<0.05）。内镜切除组病灶的整块切除率为96.0%，完全切除率为94.2%，治愈性切除率为82.1%。浸润深度是导致分块切除、不完全切除以及非治愈性切除的危险因素（ P<0.05）。结论：早期结直肠癌的淋巴结转移率极低，术前充分判断病灶的性质和浸润深度，有助于选择更为合理的治疗方式。对可能浸润至黏膜下层的病灶行内镜切除应更为慎重，以期提高内镜切除的疗效。
揹景：早期結直腸癌因淋巴結轉移率低而預後良好，如何提高其檢齣率併選擇閤理的治療方式是亟待解決的臨床問題。目的：分析早期結直腸癌在內鏡切除或手術後的病理特點，評價內鏡切除的療效。方法：迴顧性分析503例接受內鏡切除或外科手術的早期結直腸癌病竈的病理資料，分析影響早期結直腸癌浸潤深度、淋巴結轉移的危險因素，併評價內鏡切除的療效。結果：早期結直腸癌的檢齣率為10.7%，淋巴結總轉移率為1.2%（6/503），其中黏膜高級彆瘤變的淋巴結轉移率為0%（0/247），黏膜下層癌為2.3%（6/256）；內鏡切除組黏膜下淺層癌的淋巴結轉移率為0%（0/31）。腫瘤位置、腫瘤直徑、組織學分型和淋巴結轉移對早期結直腸癌的浸潤深度有顯著影響（P<0.05）。內鏡切除組病竈的整塊切除率為96.0%，完全切除率為94.2%，治愈性切除率為82.1%。浸潤深度是導緻分塊切除、不完全切除以及非治愈性切除的危險因素（ P<0.05）。結論：早期結直腸癌的淋巴結轉移率極低，術前充分判斷病竈的性質和浸潤深度，有助于選擇更為閤理的治療方式。對可能浸潤至黏膜下層的病竈行內鏡切除應更為慎重，以期提高內鏡切除的療效。
배경：조기결직장암인림파결전이솔저이예후량호，여하제고기검출솔병선택합리적치료방식시극대해결적림상문제。목적：분석조기결직장암재내경절제혹수술후적병리특점，평개내경절제적료효。방법：회고성분석503례접수내경절제혹외과수술적조기결직장암병조적병리자료，분석영향조기결직장암침윤심도、림파결전이적위험인소，병평개내경절제적료효。결과：조기결직장암적검출솔위10.7%，림파결총전이솔위1.2%（6/503），기중점막고급별류변적림파결전이솔위0%（0/247），점막하층암위2.3%（6/256）；내경절제조점막하천층암적림파결전이솔위0%（0/31）。종류위치、종류직경、조직학분형화림파결전이대조기결직장암적침윤심도유현저영향（P<0.05）。내경절제조병조적정괴절제솔위96.0%，완전절제솔위94.2%，치유성절제솔위82.1%。침윤심도시도치분괴절제、불완전절제이급비치유성절제적위험인소（ P<0.05）。결론：조기결직장암적림파결전이솔겁저，술전충분판단병조적성질화침윤심도，유조우선택경위합리적치료방식。대가능침윤지점막하층적병조행내경절제응경위신중，이기제고내경절제적료효。
Background:Prognosis of early colorectal carcinoma( ECC)is well because of low rate of lymph-node metastasis ( LNM). How to improve the detection rate and select appropriate therapy for ECC has been an eager task in clinical practice. Aims:To analyze the pathological features of ECC treated by endoscopic resection(ER)or surgery,and evaluate the therapeutic efficacy of ER. Methods:Pathological data of 503 ECC lesions treated by ER or surgery were retrospectively analyzed. Risk factors of infiltration depth,LNM of ECC were analyzed,and therapeutic efficacy of ER was evaluated. Results:The overall detection rate of ECC was 10. 7%. The incidence of LNM was 1. 2%(6/503);the LNM incidence of mucosal high-grade neoplasia was 0%( 0/247 ),while was 2. 3%( 6/256 ) in submucosal carcinoma. The LNM incidence of submucosal superficial carcinoma treated by ER was 0%( 0/31 ). Tumor location, size,histological type and LNM had significant impacts on infiltration depth(P<0. 05). The rates of en bloc,complete and curative resection by ER were 96. 0%,94. 2% and 82. 1%,respectively. Infiltration depth was the risk factor of piecemeal,incomplete and noncurative resection of ER(P<0. 05). Conclusions:The incidence of LNM in ECC is extremely low. Accurate evaluation of character and infiltration depth of lesion before operation is helpful for selecting appropriate therapy. It should be cautious to choose ER for lesions infiltrated into submucosa,thereby to improve the therapeutic efficacy of ER.
