191例小于2cm早期结直肠癌临床内镜特征分析

摘要

Objective: To examine endoscopic features of early colorectal carcinomas smaller than 2 cm. Methods: A total of 191 pa-tients (201 early colorectal carcinomas) who were definitely diagnosed with early colorectal cancer smaller than 2 cm between Janu-ary 2014 and December 2017 in Beijing Shijitan Hospital, Capital Medical University were enrolled. The patients'clinical characteris-tics, endoscopic and pathological data were retrospectively analyzed. Results: There were more male patients than female patients (1.81:1) in the study population; distribution of lesions was higher in the left colon than in the right colon (141/201). Group 1 had a higher number of IIa lesions (20/67, P=0.037) and a lower number of Ip lesions than Group 2 (52/134, P<0.01). Conclusions: There are special characteristics in distribution and endoscopic manifestations of early colorectal carcinoma. Lesion size was less than 1 cm in 67 (191 cases of early colorectal cancer) early colorectal carcinoma cases; however, a high-risk adenoma is defined as a lesion larger than 1 cm in size. Therefore, regardless of lesion size, if fractionation, echinodermata, congestion, erosion, expansion, and depression are observed, the lesion should be assessed in detail for the sake of carcinogenesis.%目的:分析较小病变(大小≤2 cm)早期结直肠癌临床内镜特征,以期指导内镜医师诊断较小早期结直肠癌,协助选择治疗方法.方法:回顾性分析首都医科大学附属北京世纪坛医院2014年1月至2017年12月收治的191例(201例早期结直肠癌病变)早期结直肠癌患者(病变大小≤2 cm)资料,分别对早期结直肠癌的临床特点、内镜特征、病理特征进行回顾性分析.结果:早期结直肠癌发病率男性高于女性(1.81:1),以左半结肠为主(141/201),<1 cm早期结直肠癌形态学以Ⅱa型为主(20/67,P=0.037)、1～2 cm早期结直肠癌形态学以Ip型为主(52/134,P<0.01).结论:早期结直肠癌在结直肠分布和内镜下表现存在一定的特征,虽然高危腺瘤定义是病变>1 cm,但本研究纳入191例早期结直肠癌患者,其中67例<1 cm.因此不论病变大小,如果内镜下观察到以下特征:分叶状、基底棘皮征、充血糜烂、病变饱满、表面凹陷等,均应警惕结直肠病变癌变可能,均应进一步详细评估.