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目的通过对腺管分型和临床病理不符的病例进行再分析,研究大肠粘膜病变腺管开口分型与组织病理学的关系,探讨内镜在初步判断大肠粘膜病变组织学类型方面的价值。方法复习结肠镜检查的影像学资料,选出腺管分型和临床病理不符的病例,分别请有经验的内镜医师及病理学专家复核该病例的腺管分型和组织病理学资料。结果共选出腺管分型和临床病理不符的病例65例,经有经验的内镜医师及病理学专家复核,20(31%)例病例的腺管分型和临床病理与原诊断完全相同,18(28%)例病例的腺管分型和原分型不同,27(41%)例病例的组织病理学诊断与原诊断不符。有1例原诊断为绒毛状腺瘤的病例,病理学专家认为局部可疑癌变。结论大肠粘膜病变的腺管开口类型与组织病理学高度相关,通过腺管分型可以初步判断大肠粘膜病变的组织学类型及良恶性。内镜医师和病理医师应加强相互的沟通和交流,以减少工作的失误。
OBJECTIVE: To study the relationship between the classification of ductal mucosa lesions and the histopathology by analyzing the classification of ductal adenocarcinoma and the clinical and pathological findings, and to explore the value of endoscopy in determining the histological type of colorectal mucosal lesions. Methods To review the imaging data of colonoscopy and to select the cases of adenocarcinoma type and clinicopathological discrepancies, and to have experienced endoscopists and pathologists review the ductal and histopathological data of the cases respectively. Results A total of 65 cases of ductal type and clinicopathological findings were selected. After review by experienced endoscopists and pathologists, the duct type and clinical pathology of 20 (31%) cases were the same as the original diagnosis , 18 (28%) cases of different types and types of glandular tuberculosis, 27 (41%) cases of histopathological diagnosis and inconsistent with the original diagnosis. A case of the original diagnosis of villous adenoma cases, pathological experts believe that local suspicious cancer. Conclusions The type of duct opening in colorectal mucosal lesions is highly correlated with histopathology. The histological types and benign and malignant lesions of colorectal mucosal lesions can be preliminarily determined by ductal typing. Endoscopists and pathologists should strengthen mutual communication and exchange to reduce the mistakes in their work.