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目的建立一套适合内镜下黏膜剥离切除标本的临床病理取材方法,以提高早期大肠癌的检出率。方法采用2005年8至12月南方医院常规结肠镜检查行内镜下黏膜剥离切除的大肠肿瘤性病变标本,对病变超过10mm以上可疑癌变的病例,采用黏膜染色,结合实体显微镜进行观察,根据腺管开口类型判断可疑癌变部位进行靶向取材病理检查,并与常规随机取材的标本进行对照,观察对大肠癌变检出率的影响,同时,将该期大肠早期癌检出情况与2004年随机取材的检出率进行对照。结果采用黏膜染色结合实体显微镜进行靶向取材,在40例可疑癌变病例中,确诊早期癌变(包括重度不典型增生)16例,这16例标本随机取材送检后,除1例病理诊断为重度不典型增生外,其余15例均为轻度或中度不典型增生。2004年同期进行非靶向取材,在54例可疑癌变的大肠肿瘤中仅检出4例早期癌变(包括重度不典型增生),检出率为7.4%。结论内镜下黏膜剥离切除标本采用黏膜染色实体显微镜进行靶向定位活检,可提高大肠早期癌变的检出率。
Objective To establish a set of clinical and pathological materials suitable for endoscopic mucosal resection specimens to improve the detection rate of early colorectal cancer. Methods The specimens of colorectal neoplasms resected by endoscopic mucosal dissection from 1994 to December 2005 in our hospital were collected and examined by mucosal staining and microscopy. The type of tube opening to determine the suspicious cancerous parts of the targeted pathological examination, and conventional random samples were compared to observe the detection rate of colorectal cancer, at the same time, the detection of colorectal cancer early in 2004 randomized The detection rate of the control. Results In mucosal staining combined with solid-state microscopy, 16 cases of early cancers (including severe atypical hyperplasia) were diagnosed in 40 cases of suspected cancers. After 16 cases were randomly selected for examination, all cases were diagnosed as severe Atypical hyperplasia, the remaining 15 cases were mild or moderate dysplasia. In the same period of 2004, non-targeted materials were taken and only 4 cases of early cancers (including severe dysplasia) were detected in 54 cases of colorectal cancer with a suspicious canceration, with a detection rate of 7.4%. Conclusion Endoscopic mucosal dissection resection specimens using mucosal staining solid-state microscope targeted biopsy can improve the detection rate of early colorectal cancer.