摘要目的 评价腺管开口分型对早期大肠癌及癌前病变检出的临床价值.方法 回顾2004年11月至2007年8月结肠镜检查,采用内镜下黏膜染色技术,结合放大内镜及实体镜观察腺管开口分型并与病理诊断对照,腺管开口分型采用工藤进英分型标准.结果 结肠镜检杳大肠病变共1496个,非肿瘤性病变占30.6%(458/1496),各类型腺瘤占43.9%(657/1496),大肠癌占25.5%(381/1496).早期大肠癌61个;大肠侧向发育型肿瘤36个,直径10～62 mm,其中Ⅱ型3个,Ⅲ1.型14个,Ⅳ型17个,Ⅴ型2个.管状腺瘤中以低级别上皮内瘤变居多,占87.5%(363/415);管状绒毛状腺瘤高级别上皮内瘤变占40.7%(61/150);绒毛状腺瘤腺管开口以Ⅳ型为主,高级别上皮内瘤变达85.7%(42/49).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的检出有重要意义,对及时进行内镜治疗或手术切除具有一定的临床指导意义.

abstractsObjective To evaluate the diagnostic value of pit pattern analysis in detection of early colorectal carcinoma.Methods From November 2004 to August 2007,a total of 1496 colorectal lesions were observed by mannifying colonoscopy with 0.4%indigo carmine staining.The mucosal crypt patterns (classified according to Kudo classification criteria)of these lesions were compared with pathological diagnosis.Results In 1496 lesions,458(30.6%)were non-neoplastic,657(43.9%)were adenoma,and 381 (25.5%)were adenocarcinoma.In 657 adenoma lesions,415 were tubular adenoma,with low grade dysplasia in 363(87.5%),150 were tubulovillous adenomas with hish grade dysplasia in 61(40.7%)and 49 were villous adenoma with hiish grade dysplasia in 42(85.7%).Among the adenocarcinoma lesions,61 were early colorectal cancers and 36 were laterally spreading tumors(LST).The LST lesions ranged from 10 to 62 mm in diameter.The pit pattern of 3 cases was Type Ⅱ,14 were Type Ⅲ,17 were Type Ⅳ and 2 were Type Ⅴ.Conclusion Pit pattern analysis is important in distinguishing tumorous lesions from non-tumorous ones and in improving the diagnosis rate of early colorectal cancer,which helps in choosing appropriate managements.