贵州医科大学学报

2020, v.45;No.235(04) 461-465

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直径小于20 mm结直肠癌黏膜下浸润内镜特征分析
Endoscopic Characteristics of Submucosal Invasion of Colorectal Cancer with less than 20 mm Diameter

李大欢;邓超男;刘雪影;徐晓雯;张家璐;许良璧;
LI Dahuan;DENG Chaonan;LIU Xueying;XU Xiaowen;ZHANG Jialu;XU Liangbi;Department of Internal Medicine,School of Clinical Medicine,Guizhou Medical University;Department of Pathology,School of Clinical Medicine,Guizhou Medical University;

摘要(Abstract):

目的:分析直径<20 mm结直肠黏膜下癌(SM期癌)的白光内镜特征。方法:直径<20 mm的结直肠癌54例,根据肿瘤浸润深度分为黏膜下癌(SM期癌)及黏膜内癌(M期癌),观察两组患者病灶的形态、部位、内镜表现以及治疗方法,比较不同浸润深度结直肠癌的内镜特征,分析不同内镜特征诊断SM期癌的敏感性、特异性及准确性。结果:54例结直肠癌中,SM期癌的大小较M期癌的大,差异无统计学意义(P=0. 080); M期癌及SM期癌常见于左半结肠,在外观形态上SM期癌以Is+IIc为主(53%);结直肠癌的内镜特征中,SM期癌组较M期癌组更易出现自发性出血、皱襞集中、鸡皮样改变及抬举征阴性(P <0. 05),而抬举征阴性在诊断SM期癌的特异性、准确性是优于鸡皮样改变; SM期非治愈性切除比例(60%)较高。结论:当直径<20 mm结直肠癌白光内镜下有自发性出血、皱襞集中、鸡皮样改变及抬举征阴性时,提示结直肠有SM层浸润的可能。
Objective: To analyze the white-light endoscopic features of colorectal submucosal carcinoma( SM stage cancer) with less than 20 mm diameter. Methods: There were 54 cases of colorectal cancer with less than 20 mm diameter,divided into submucosal carcinoma( SM stage cancer) and intramucosal carcinoma( M stage cancer) according to the depth of tumor invasion. The morphology,location,endoscopic manifestations and treatment methods of the lesions in the two groups were observed,the endoscopic features of colorectal cancer with different depth of infiltration were compared,and the sensitivity,specificity and accuracy of different endoscopic features in the diagnosis of SM stage cancer were analyzed. Results: The size of SM stage cancer was larger than that of M stage cance in 54 colorectal cancers,and the difference was not statistically significant( P = 0. 080). M Stage cancer and SM stage cancer were common in the left colon and Is + IIc in appearance and morphology( 53%). The endoscopic features of colorectal cancer showed that spontaneous hemorrhage,concentration of folds,skin-like changes and negative lift sign were more common in SM cancer group than in M cancer group( P < 0. 05). However,the specificity and accuracy of the negative lift sign in the diagnosis of SM stage cancer was better than that of chicken skin-like changes,and the proportion of non-healing resection in SM stage( 60%) was higher. Conclusion: If spontaneous hemorrhage,concentration of folds,skin-like changes and lift sign are negative under white light endoscopy with less than 20 mm diameter,SM layers of colorectal infiltration are suggested.

关键词(KeyWords): 结直肠肿瘤;诊断,鉴别;误诊;白光内镜;浸润;黏膜下
colorectal neoplasms;diagnosis,differential;diagnostic errors;white endoscopy;infiltration;submucosal

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基金项目(Foundation): 贵州省教育厅青年科技人才成长项目[黔教合KY字(2018)178]

作者(Author): 李大欢;邓超男;刘雪影;徐晓雯;张家璐;许良璧;
LI Dahuan;DENG Chaonan;LIU Xueying;XU Xiaowen;ZHANG Jialu;XU Liangbi;Department of Internal Medicine,School of Clinical Medicine,Guizhou Medical University;Department of Pathology,School of Clinical Medicine,Guizhou Medical University;

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DOI: 10.19367/j.cnki.1000-2707.2020.04.016

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