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目的LST因与大肠癌关系密切,其生长方式不同于一般的隆起样肿瘤,本文总结39例LST在染色及放大内镜后行EMR及EPMR诊断与治疗的经验。方法内镜检查发现肠道黏膜发红或粗糙、血管网不清或消失等病变,行染色后放大内镜观察其腺管开口类型。结果2年中共发现39例LST病变。其中黏膜内癌1例,锯齿状肿瘤1例。39个病变内镜分型颗粒均一型18个,结节混合型20个,假凹陷型1个。病变最大为35 mm×43 mm;11~20 mm 12个,21~30 mm 15个,30 mm以上12个。大肠黏膜腺管开口类型ⅢL型21个,其中17个为管状腺瘤;Ⅳ型14个,其中10个为绒毛状腺瘤;Ⅴ型1个,为黏膜内癌。所有病例均行EMR或EPMR切除。结论应用黏膜染色技术和放大内镜有助于LST的诊断,内镜窄带成像术能缩短检查时间。LST的腺管开口大多数表现为ⅢL型或Ⅳ型,ⅢL型腺管开口多为管状腺瘤,Ⅳ型腺管开口多为绒毛状腺瘤,一旦出现Ⅴ型腺管开口则表明已经有癌变发生。无症状人群的检查也是发现早期大肠癌的重要方式。
Purpose LST is closely related to colorectal cancer and its growth pattern is different from that of normal protuberant tumors. This review summarizes the experience of diagnosis and treatment of EMR and EPMR by 39 cases of LST after staining and magnifying endoscopy. Methods Endoscopy showed redness or rough gut mucosa, vascular network unclear or disappear and other lesions, the magnification of endoscopic observation of the type of open duct. Results A total of 39 LST lesions were found in 2 years. One mucosal carcinoma in 1 case, serrated tumor in 1 case. Thirty-nine lesions were homogenized with endoscopic type particles of 18, nodular mixed type 20, and pseudotubated type 1. The largest lesions were 35 mm × 43 mm, 12 to 11-20 mm, 15 to 21-30 mm and 12 to 30 mm. There were 21 type III L of colorectal mucosa, of which 17 were tubular adenoma, 14 were type Ⅳ, 10 were villous adenoma and 1 was type V, which was intramucosal carcinoma. All cases underwent EMR or EPMR resection. Conclusion The application of mucosal staining and magnifying endoscopy is helpful for the diagnosis of LST. Endoscopic narrowband imaging can shorten the examination time. Most of the LST duct openings showed type III or IV. Most of the type III L duct openings were tubular adenomas. The type IV duct openings were mostly villous adenomas. Once the type V duct openings appeared, it indicated that there was already a cancerous occur. Asymptomatic screening of people is also an important way to detect early colorectal cancer.