摘要
目的研究染色放大肠镜下大肠息肉样病变腺管开口的形态与组织病理学的关系。方法使用0.5%美蓝对大肠息肉样病变部位进行染色,然后用放大电子结肠镜观察记录腺管开口的形态,进行活检电切后观察组织学变化。结果53例患者,普通电子结肠镜检出息肉56枚,经美蓝染色放大后又发现0.2～0.4cm大小的息肉29枚,共计息肉样病变85枚。染色放大结肠镜可明显提高息肉病变的检出率(P<0.001)。pit分型Ⅰ型11枚,Ⅱ型7枚,ⅢS型4枚,ⅢL型18枚,Ⅳ型21枚,Ⅴ型10枚,混合型14枚;85枚息肉样病变的组织学结果,增生性息肉30枚,管状腺瘤29枚,腺癌5枚,慢性炎症5枚,管状绒毛状腺瘤l3枚,绒毛状腺瘤2枚,炎性息肉1枚。PitⅠ-ⅢS型中没有出现绒毛状腺瘤改变,相应的组织学改变为增生性息肉或管状腺瘤。pitⅢL-V型均有绒毛形成。结论观察染色放大肠镜下病变黏膜腺管开口的形态变化有助于判断大肠息肉样病变绒毛或乳头形成,与组织病理学结果有一致性,且可明显提高息肉病变的检出率。
[ Objective ] To study the relationship between histopathology and the pit shape of colorectal polypoid lesions detected by the chromomaynifying endoscope with methylene blue. [Methods] After 5 g/L methylene blue solution was sprayed to the surface of eolorectal polypoid lesions, the normal mucosa and polypoid lesions were observed with the magnifying electronic eolonoscope. The pit patterns of colorectal mucosa and polypoid lesion were observed and recorded according to shin-eikudo＇S criteria. Then the polypoid lesion biopsy specimens were sent for histopathologic evaluation. [Results] In 53 patients with visible polypoid lesions, 56 polypoid lesions were found. Twenty-nine more lesions with a size of 0.2-0.4 cm were discovered by chromoendoscopy with methylene blue. The detection rate of adenomatous lesion was obviously raised by chromomagnifying electronic colonoscope （P 〈0.001）. The pit patterns of 85 polypoid lesions were classified into six categories： type I in 11 samples, type II in 7, type ⅢS in 4, type ⅢL in 18, type IV in 21, type V in 10 and mixed type in 14. The histopathologic results in 85 polypoid lesions showed hyperplastie polyps in 30 samples, tubular adenoma in 29, adenocarcinoma in 5, chronic inflammation in 5, tubular-villose adenoma in 13, inflammatory polyps in 1 and villose adenoma in 2. By comparison between pit types and histopathologic changes, villous adenoma had not been found in types Ⅰ -Ⅲ S pits, their histopathologic changes were hyperplastic polyps or tubular adenomas; villose formation was observed in types Ⅲ L -V pits. [ Conclusions ] The detection rate of adenomatous lesions in eolorectum can be obviously raised by observation of the pit types under chromo-magnifying endoscope. That is helpful to detect the villose or papillary formation in eolorectal polypoid lesions.
出处
《中国内镜杂志》
CSCD
北大核心
2009年第8期793-795,800,共4页
China Journal of Endoscopy
关键词
放大内镜
腺管
息肉样病变
病理组织学
ehromo-magniifying endoscope
pit
polypoid lesion
histopathology
