提高早期大肠癌诊断的研究_医学论文.docVIP

提高早期大肠癌诊断的研究_医学论文 提高早期大肠癌诊断的研究_医学论文 【摘要】 目的 1905年首次钡灌肠X线检查被用于临床诊断大肠病变以来，大肠镜的问世，为提高早期大肠癌的诊断和治疗，提供了最简便、最安全、最有效的方法。 方法 对422例扁平增生性病变和112例凹陷型病变，不凭主观臆断，都进行活检组织连续切片病理学的诊断。对内镜下高频电切摘除的2969例（3153枚）息肉进行全瘤病理连续切片。 结果 发现早期大肠癌171例（7.0%），腺瘤性早期癌165例，非腺瘤性早期癌6例。87例为小的扁平腺瘤，9例为凹陷性腺瘤。 结论 就目前而言，95%以上大肠的早期癌是从腺瘤演变而来，而且是由内镜检查或电切摘除后发现的。大肠腺瘤经肠镜下及时发现和治疗后，终止了其瘤变的发生，能有效的防止和降低大肠癌发生。因此，重要问题是临床医生尤其是内镜医生，必需重新认识大肠腺瘤的概念，充分了解并认识到这些早期大肠癌和腺瘤的不同形态的存在。提高肠镜下对小病灶大肠癌，小的扁平腺瘤和凹陷性腺瘤的识别能力，才能提高早期大肠癌检出率。 　　【关键词】 小的病变；形态；早期癌；全瘤切片 　　The research of the diagnosis improvement of early colorectal cancer 　 　　【Abstract】 Objective The examination of barium enema ever since 1905,colonoscope occurrence,it is very development to diagnose in small nonpolypoid lesion of large bowel.Especially to be defected in colorectal small flat and depressed adenoma and early cancer,it is most convenience,safe and utility. Methods 422 cases with flat lesion and 112 cases with depressed lesion were performed biopsy,2969 cases (3153) with adenomas were resected under endoscope.It is certainly to obtain pathological biopsy when it is detected in small lesion. Results There were detected by colonoscopy in 171 cases with early cancer,among them,there were proved 165 cases with adenoma,6 cases with non adenoma early cancer,3 cases with Ⅱa type,3 cases with Ⅱc type.Among 2683 cases with adenomas, 87 cases with small flat adenoma, 9 cases with depressed adenoma were confirmed. Conclusion In point of fact,95% with early cancer are defected by colonoscopy.It is most important to detect and treat promptly various adenoma,which is important significance to prevent and depress the incidence of colorectal cancer. 　　【Key words】 small lesionmorphologyearly cancerserial sections 　　1905年首次钡灌肠X线检查被用于临床诊断大肠病变以来，大肠镜的问世是大肠疾病诊断的革命。为提高早期大肠癌的诊断和治疗，提供了最简便、最安全、最有效的方法。尤其是对癌前期病变——大肠扁平和凹陷性腺瘤形态的研究和小病灶早期大肠癌的诊断和治疗的研究提供了有利的条件。 　　1 材料与方法 　　1986年5月～2005年6月，共行结肠镜检查31017例，其中大肠癌和腺瘤术后定期无症状随访检查1637例（5.3%）。发现大肠癌2475例（7.9%），大肠腺瘤3256例（10.5%）。在检查过程中，对肠管清洁准备不 佳，进行重新准备。对42