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目的 评价腺管开口分型对诊断早期大肠癌及癌前病变的临床实用价值。方法 2 0 0 0年 11月～ 2 0 0 2年 8月结肠镜检查 4 176例次 ,采用内镜下黏膜染色技术 ,部分病变结合放大内镜及实体显微镜观察腺管开口分型 (pit分型 )并与病理诊断对照 ,pit分型采用工藤分型。 结果 75 2例患者发现大肠隆起、扁平等不同病变共 95 5个 ,共检出早期大肠癌 14例 ,进展期癌 2 0 9例 ,Ⅱa、Ⅱb、Ⅱc、Ⅱa +Ⅱc病变 76个。侧向发育型肿瘤 (LST型 )病变 4 3个 ,直径 16～ 110mm ,其中Ⅱ型 2个 ,ⅢL18个 ,Ⅳ 19个 ,ⅤA 型 1个 ,ⅤN 型 3个。非肿瘤性息肉以Ⅰ、Ⅱ型腺管开口为主 ,占 85 .4 % (30 3/ 35 5 ) ;而腺瘤性息肉则以Ⅲ、Ⅳ型腺管开口为主 ,占 86 .0 % (5 0 4 / 5 86 ) ;进展期癌均表现为黏膜腺管开口破坏无结构 ,为ⅤN 型 ;14例早期癌中有 8例腺管开口为Ⅴ型 ,其中ⅤA 型 2个 ,ⅤN 型 6个。结论 大肠腺管开口分型对于判断肿瘤性、非肿瘤性病变以及早期大肠癌并指导及时的内镜治疗或手术切除具有重要意义及临床实用价值
Objective To evaluate the clinical value of open duct typing in the diagnosis of early colorectal cancer and precancerous lesions. Methods Between November 2000 and August 2002, colonoscopy was performed 4,176 times. Endoscopic mucosal staining was used. Some lesions were examined by magnifying endoscopy and microscopy. Type) and pathological diagnosis control, pit type using Kudo classification. Results A total of 755 cases of colorectal mucosa were found in 752 cases. There were 14 cases of early stage colorectal cancer, 209 cases of advanced stage cancer, 76 cases of Ⅱa, Ⅱb, Ⅱc and Ⅱa + Ⅱc. There were 43 lesions of lateral developmental type (LST type) with diameter of 16-110 mm, of which 2 were type Ⅱ, 18 were Ⅲ L18, 19 were Ⅳ, 1 was Ⅴ A and 3 were Ⅴ N. Non-tumorous polyps were mainly type I and type II ductal openings, accounting for 85.4% (30 3/35 5); while adenomatous polyps were mainly type III and IV duct openings, accounting for 86.0% (5 0 4/5 86). The advanced carcinoma showed mucosal ductal destruction without any structure and type ⅤN. In 14 cases of early stage carcinoma, there were 8 cases with type V Ⅴ, of which 2 ⅤA and ⅤN 6 Conclusion The classification of colorectal duct opening is of great significance and clinical value in judging tumor, non-neoplastic lesions and early colorectal cancer and guiding timely endoscopic treatment or surgical resection