CAJ | 학술논문

目的分析肠镜活检诊断为结直肠高级别上皮内瘤变的临床病理特征及外科治疗对策.方法对2005年1月-2012年12月收治经内镜活检病理诊断为高级别上皮内瘤变的结直肠肿瘤患者82例的临床资料进行回顾性分析.71例行根治性结直肠癌手术,其中包括1例扩肛多次局切后术中病理补充行miles术,其他3例行单纯扩肛肿瘤切除术,8例行姑息性肿瘤切除术.将术后诊断与肠镜活检诊断进行比较分析.结果术后病理3例(3.7％)仍为高级别上皮内瘤变,肿瘤直径1～3 cm,平均1.5 cm；其余79例(96.3％)证实为黏膜下层浸润性腺癌,肿瘤直径1 ～11 cm,平均4.7 cm,两组肿瘤最大直径差异有统计学意义(P＜0.01).Kappa一致值为0.104,术前术后差异较大,一致性较差.统计分析显示肿瘤癌变与大小和浸润深度相关.证实为腺癌的79例中已有8例出现肝转移,31例(39.2％)有局部区域性淋巴结转移；33例直肠肿瘤中(包括1例多原发性肿瘤)有30例(90.9％)术后病理证实为腺癌.结论要重视结直肠上皮内瘤变的病理诊断,诊断为高级别上皮内瘤变的肿瘤患者绝大多数已存在浸润性癌,甚至有区域性淋巴结转移及远处转移.如肿瘤位置不涉及保肛的问题,结直肠肿瘤直径大于3 cm者,应首选作病变肠段的切除,术中病理诊断为浸润性腺癌,则应行根治性手术.对于低位直肠肿瘤应当多次内镜活检和或扩肛肿块切除后再决定治疗方案.
목적 분석장경활검진단위결직장고급별상피내류변적림상병리특정급외과치료대책.방법 대2005년1월-2012년12월수치경내경활검병리진단위고급별상피내류변적결직장종류환자82례적림상자료진행회고성분석.71례행근치성결직장암수술,기중포괄1례확항다차국절후술중병리보충행miles술,기타3례행단순확항종류절제술,8례행고식성종류절제술.장술후진단여장경활검진단진행비교분석.결과 술후병리3례(3.7％)잉위고급별상피내류변,종류직경1～3 cm,평균1.5 cm；기여79례(96.3％)증실위점막하층침윤성선암,종류직경1 ～11 cm,평균4.7 cm,량조종류최대직경차이유통계학의의(P＜0.01).Kappa일치치위0.104,술전술후차이교대,일치성교차.통계분석현시종류암변여대소화침윤심도상관.증실위선암적79례중이유8례출현간전이,31례(39.2％)유국부구역성림파결전이；33례직장종류중(포괄1례다원발성종류)유30례(90.9％)술후병리증실위선암.결론 요중시결직장상피내류변적병리진단,진단위고급별상피내류변적종류환자절대다수이존재침윤성암,심지유구역성림파결전이급원처전이.여종류위치불섭급보항적문제,결직장종류직경대우3 cm자,응수선작병변장단적절제,술중병리진단위침윤성선암,칙응행근치성수술.대우저위직장종류응당다차내경활검화혹확항종괴절제후재결정치료방안.
Objective To analyze the clinical and pathological characteristics and its surgical management strategy for colorectal high-grade intraepithelial neoplasia (HGIN).Methods Eighty-two cases with colorectal tumors diagnosed as colorectal HGIN based on colonoscopic biopsy between January 2005 and December 2012 were enrolled in the study.The clinicopathological data of all the patients was collected and analyzed.Of the 82 cases,71 cases had radical colorectal surgery,1 cases had Miles operation after previous transanal excisions,3 had transanal local excisions,8 cases had palliative surgery.The surgical specimens were all examined pathologically and compared with the preoperative diagnosis of colonoscopic biopsy of all the patients.Results Three cases (3.7％) were pathologically diagnosed as high-grade intraepithelial neoplasia,their average diameter was 1.5 cm.The other 79 (96.3％) cases were diagnosed as adenocarcinoma,with an average diameter of 4.7 cm.The difference in tumor size was statistically significant (P ＜ 0.01).Comparison of pre-and post-operative specimens showed poor consistency,the Kappa value was O.104.Significant analysis showed a correlation between cancerous change to tumor size and depth of invasion.In the 79 cases confirmed as adenocarcinoma,liver metastasis occurred in 8 cases,regional lymph nodes metastasis in 31 cases (39.2％).Of the 33 cases with rectal tumors,30 cases (90.9％) were pathologically diagnosed as adenocarcinoma after operation.Conclusions Much attention should be payed to the pathological diagnosis in colorectal intraepithelial neoplasia,especially in the HGIN.We have found that of the cases first diagnosed as HGIN,approximately 96.3％ already have invasion adenocarcinoma.Most cases had reginonal lymph nodes metastasis.Liver metastasis had been occurred.thus active surgical measures should be taken.If the location of the tumor was not involved to anal sphincter,or cases with tumors larger than 3 cm was diagnosed,in highly suspected cases with malignant potiential,radical surgery is recommended.For tumors located at the lower rectum,the final decision should be made only after repeated endoscopic or transanal biopsy.