摘要目的 探讨内镜在平坦型大肠肿瘤浸润深度判断及治疗方式选择中的作用.方法 222例大肠平坦型病变根据腺管开口类型及空气介导变形试验和抬举试验判断肿瘤浸润深度,空气介导变形试验和抬举试验均为阳性选择内镜下治疗,否则行手术治疗.经内镜或外科手术切除的标本均完整送检,按WHO的病理学标准做出组织病理学诊断.计算空气介导变形试验和抬举试验判断肿瘤浸润深度的敏感度、特异度、阳性预测值、阴性预测值和准确度.结果 空气介导变形试验和抬举试验阳性者212例,其中192例行内镜黏膜切除术(EMR),15例行内镜下黏膜分片切除术(EPMR),2例行EPMR+外科手术治疗,3例行手术治疗.空气介导变形试验和(或)抬举试验阴性者10例,4例行手术治疗.空气介导变形试验和抬举试验判断肿瘤浸润深度的敏感度为97.2%,特异度为44.4%,阳性预测值为97.6%,阴性预测值为40.0%.结论 空气介导变形试验和抬举试验可大致判断平坦型大肠肿瘤浸润深度,指导即时的治疗方式选择,有利于防止过度治疗或治疗不足.

abstractsObjective To evaluate the use of endoscopy in assessment of invasion depth of colorectal flat lesions and in choice of treatment strategy. Methods The invasion depth of 222 colorectal flat lesions from 188 patients was endoscopically estimated by pit patterns, air-induced deformation testing and/or lifting sign. The lesion was endoscopically rosected if both tests were positive, otherwise, surgery was applied. The pathological evaluation of resected lesion was made according to WHO criteria and was used as a reference of tumor invasion depth. The sensitivity, specificity, positive and negative predictive value of airinduced deformation testing and lifting sign in prediction of invasion depth of tumors were calculated. Results The air-induced deformation testing and lifting sign were both positive in 212 cases, in which 192 were treated with endoscopic mucosal resection (EMR), 15 with endoscopic piecemeal mucosal resection (EPMR), 2 with additional surgery after EPMR and 3 with surgery only. Either air-induced deformation tesring or lifting sign was negative in 10, in which 4 cases underwent surgical resection. The sensitivity, specificity, positive and negative predictive value of air-induced deformation testing and lifting sign in prediction of invasion depth of tumors were 97.2%, 44. 4%, 97.6% and 40. 0%, respectively. Conclusion Endoscopic air-induced deformation testing and lifting sign can be used to predict invasion depth of colorectal flat tumors, which can guide instant therapeutic strategies and avoid excessive or insufficient treatments.