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目的研究早期大肠癌及其癌前病变的放大内镜下特点及其与浸润深度的关系。方法应用电子放大内镜加靛胭脂染色观察了108例患者共129个大肠隆起性病变。结果129个病变中经病理诊断为肿瘤性病变(腺瘤及癌)的有106个。其腺管开口呈Ⅱ型者10个、ⅢL型者73个、Ⅲs型者1个、Ⅳ型者7个、Ⅴ型者15个,没有Ⅴ型单独存在者。10个腺管开口Ⅱ型者病变病理多为轻度异型,无重度异型。15个出现Ⅴ型结构的病变中,10例癌变,5例病理为重度异型。10个癌变病变中均出现了Ⅴ型结构,7个黏膜内癌中6个呈ⅤA型,1个ⅤN型;2个黏膜下层癌均呈ⅤN型;一个进展期癌呈ⅤN型。研究中观察到10个侧向发育型肿瘤(LST),放大内镜下腺管开口呈ⅢL型、Ⅳ型或Ⅴ型,其中1例癌变。结论放大内镜与实体显微镜观察息肉腺管开口形态基本一致。通过腺管开口观察可以很好的区分肿瘤性病变与非肿瘤性病变,其对肿瘤性病变的诊断具有重要的应用价值。
Objective To study the characteristics of magnifying endoscopy and its relationship with the depth of invasion in early stage colorectal cancer and its precancerous lesions. Methods E-magnification endoscopy plus indigo rouge observation of 108 patients with a total of 129 cases of colorectal lesions. Results Of the 129 lesions pathologically diagnosed as neoplastic lesions (adenomas and carcinomas), there were 106. There were 10 type Ⅱ glands in the duct, 73 type Ⅲ L type, 1 type Ⅲs type, 7 type Ⅳ type and 15 type Ⅴ type. There was no type V alone. Pathological changes of 10 ductal type Ⅱ were mild atypia and no severe atypia. Of the 15 lesions with Ⅴ-type structure, 10 were cancerous and 5 were pathologically severe. There were Ⅴ-type structures in 10 cancerous lesions, 6 of 7 intramucosal carcinomas were type ⅤA and 1 ⅤN; 2 submucosal carcinomas were ⅤN-type; one of advanced cancers was ⅤN-type. Ten lateral developmental tumors (LSTs) were observed in the study. Enlarged endoscopic parenchyma was type IIIL, IV or V. One of the tumors was cancerous. Conclusion magnifying endoscopy and solid microscope observation of the shape of the polyp duct opening basically the same. Through the observation of the opening of the ducts, it is possible to distinguish the neoplastic and non-neoplastic lesions well, which is of great value in the diagnosis of neoplastic lesions.