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| 113例早期结直肠癌及癌前病变内镜黏膜下剥离术标本处理及病理学评估 | |
| 其他题名 | Specimen processing and pathological evaluation of 113 samples of early colorectal cancer and precancerous lesion after endoscopic submucosal dissection |
| 梁丽1; 于妍斐1; 张继新1; 农琳1; 戎龙2; 年卫东2; 蒋梦婉3; 柳萍1; 李挺1 | |
| 来源期刊 | 中华消化内镜杂志
 |
| ISSN | 1007-5232 |
| 出版年 | 2018 |
| 卷号 | 35期号:7页码:470-476 |
| 中文摘要 | 目的探讨早期结直肠癌及癌前病变内镜黏膜下剥离术(ESD)标本的规范化病理评估及其重要意义。方法选自2012年8月至2016年6月间本院内镜中心行结直肠ESD治疗的连续性113例早期结直肠癌和癌前病变,参照日本结直肠癌处理指南,进行标本规范化处理和病理学评估,包括组织学类型、肿瘤最大径、肿瘤浸润深度、出芽分级、脉管侵犯情况、水平及垂直切缘情况,并综合评估病例的治愈性或非治愈性切除等。结果病理诊断结直肠腺瘤63例(55. 75%),其中管状腺瘤29例(25. 66%),绒毛状腺瘤2例(1. 77%),绒毛管状腺瘤32例(28. 32%)。锯齿状病变34例(30. 09%),包括传统型锯齿状腺瘤19例(16. 81%),无柄锯齿状腺瘤11例(9. 73%),增生性息肉4例(3. 54%)。浸润性腺癌16例(14. 16%),包括高分化腺癌7例,中分化腺癌7例,低分化腺癌1例,黏液腺癌1例。病理评估发现,16例早期浸润性结直肠癌,2例有脉管癌栓,均为发生于乙状结肠的中分化腺癌。108例垂直切缘阴性(95.58%) ,1例垂直切缘阳性(中分化浸润性腺癌,pT1b2),1例垂直切缘可疑阳性,3例无法准确评估。80例(70. 80%)水平切缘阴性,20例(17. 70%)水平切缘阳性(19例腺瘤,1例中分化腺癌),13例无法准确评估。术后评估显示,113例ESD标本中病变完整切除率为82. 30%,大肠浸润性腺癌的病变完整切除率为93.75%。16例大肠浸润性腺癌,术后治愈性切除5例(治愈性切除率31. 25%),非治愈性切除11例。其中7例非治愈性切除追加手术,余随访未见复发。结论标本规范处理、全面准确的病理学评估是结直肠ESD技术发展关键因素,对内镜治疗取得长期成功非常重要。 |
| 英文摘要 | Objective To study the pathology and its significance of early colorectal cancer and precancerous lesions treated by endoscopic submucosal dissection (ESD) . Methods A total of consecutive 113 cases were collected at the endoscopy center from August 2012 to June 2016, which were diagnosed as early colorectal cancer and precancerous lesions and undergone ESD. According to Japanese colorectal cancer treatment guidelines,specimens were processed and pathologically evaluated for histological type, tumor diameter, depth of invasion, budding grading, vessel invasion, and horizontal and vertical margin, as well as curative resection. Results There were 63 cases of adenoma (55. 75%),including 29 (25. 66%) tubular adenoma, 2(1. 77%) villous adenoma, and 32 (28.32%) villioustublar adenoma. Thirty-four oases of serrated lesion were found, which included 19(16. 81%) traditional serrated adenoma, 11(9. 73%) sessile serrated adenoma, and 4(3. 54%) hyperplasic polyp. There were also 16(14. 16%) cases of early colorectal cancer with 7 cases of well-differentiated adenocarcinoma, 7 cases of moderately-differentiated adenocarcinoma, 1 case of poorly-differentiated adenocarcinoma, and 1 case of mucinous adenocarcinoma. Vessel invasion were observed in 2 of 16 cases of early colorectal cancer which were both moderately-differentiated adenocarcinoma in sigmoid colon. The vertical margins were negative in 108(95. 58%) of 113 cases. Positive vertical margin were found in only 1 case (moderately-differentiated adenocarcinoma, pTlb2) and another case was suspected as positive. The rest 3 cases could not be precisely diagnosed. The horizontal margins were negative in 80(70.80%) of 113 cases and positive horizontal margin were found in 20 (17.7%) cases (19 adenoma and 1 moderately-differentiated adenocarcinoma). Thirteen cases cannot be precisely diagnosed. Histologically, complete resection rate was 82. 30%. The complete resection rate of invasive adenocarcinoma was 93. 75%. Among 16 cases of invasive adenocarcinoma, 5 cases (curative rate: 31. 25%) were judged as curative resection whereas 11 cases were considered as non-curative resection. Seven non-curative resection cases were treated with further surgery and did not relapse after the follow-up. Conclusion The standardized processing and precise histopathological evaluation are key factors for colorectal ESD technique,which play an important role in the success of endoscopic therapy. |
| 中文关键词 | 结直肠肿瘤 ; 早期诊断 ; 病理学,临床 ; 内镜黏膜下剥离术 |
| 英文关键词 | Colorectal neoplasms Early diagnosis Pathology,clinical Endoscopic submucosal dissection |
| 语种 | 中文 |
| 国家 | 中国 |
| 收录类别 | CSCD |
| WOS类目 | MEDICINE GENERAL INTERNAL |
| WOS研究方向 | General & Internal Medicine |
| CSCD记录号 | CSCD:6281776 |
| 资源类型 | 期刊论文 |
| 条目标识符 | http://119.78.100.177/qdio/handle/2XILL650/238877 |
| 作者单位 | 1.北京大学第一医院病理科, 北京 100034, 中国; 2.北京大学第一医院内镜中心, 北京 100034, 中国; 3.北京健宫医院病理科 |
| 推荐引用方式 GB/T 7714 | 梁丽,于妍斐,张继新,等. 113例早期结直肠癌及癌前病变内镜黏膜下剥离术标本处理及病理学评估[J],2018,35(7):470-476. |
| APA | 梁丽.,于妍斐.,张继新.,农琳.,戎龙.,...&李挺.(2018).113例早期结直肠癌及癌前病变内镜黏膜下剥离术标本处理及病理学评估.中华消化内镜杂志,35(7),470-476. |
| MLA | 梁丽,et al."113例早期结直肠癌及癌前病变内镜黏膜下剥离术标本处理及病理学评估".中华消化内镜杂志 35.7(2018):470-476. |
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