摘要目的 通过对比分析结直肠黏膜内癌与黏膜下癌的白光内镜下形态学差异,总结有助于判断早期结直肠癌浸润深度的形态特征.方法 回顾性分析北京军区总医院消化内镜中心2010年1月至2015年9月经结肠镜检查发现并经病理证实的早期结直肠癌病例,分析其形态特征与浸润深度之间的关系.结果 共纳入早期结直肠癌319例,病灶多见于直肠与乙状结肠,其中黏膜内癌259例,黏膜下癌60例.黏膜内癌与黏膜下癌在病灶直径方面无统计学差异,但黏膜下癌的直径均≥1 cm.0-Ⅰs型病变中黏膜下癌较多见.黏膜下癌中51.7％(31/60)可见边界清晰的凹陷,23.3％(14/60)有表面饱满感,20.0％ (12/60)可见表面糜烂或破溃,这些特征在判断病灶为黏膜内癌或黏膜下癌中均有统计学意义(P＜0.05).结论 早期结直肠癌中形态学分型为0-Ⅰs型,肉眼白光内镜下观察到病灶表面局部饱满、有边界清晰的凹陷或局部糜烂、破溃特征时,有助于黏膜下癌的判定.

abstractsObjective To study the relationship between morphological characteristics of early colorectal cancer under the white light endoscopy and its infiltration depth by comparing the morphological differences between colorectal cancer within the mucosa and submucosal carcinoma.Methods Data of early colorectal cancer cases which were detected by colonoscopy and confirmed by pathology,at digestive endoscopy center of Beijing Military Region General Hospital between January 2010 and September 2015 were retrospectively studied.The relationship between the morphological characteristics and the tumor invasive depth was analyzed.Results There were 319 early colorectal cancer cases enrolled,most of which were located in the rectum and sigmoid colon.Two hundred and fifty-nine cases were intramucosal carcinoma,while sixty cases were submucosal cancer.There was no significant difference between mucosal carcinoma and submucosal carcinoma in their diameters.But the diameter of all submucosal carcinomas was larger than 1 cm.The most common macroscopic morphology of 0-Ⅰ s type was submucosal carcinoma.51.7％ (31/60) submucosal carcinomas showed epressed area with clear boundary,23.3％ (14/60) showed fullness on the surface,visible ulceration or errhysis on surface could be seen in 20.0％ (12/60) lesions.These characteristics were statistically significant in judging whether the lesion was mucosal cancer or submucosal cancer (P＜0.05).Conclusion Early colorectal cancer of 0-Ⅰ s type,and the morphological characteristics of epressed area with clear boundary,fullness,ulceration or errhysis on surface under the white light endoscopy are helpful in the determination of submucosal cancer.