内镜切除结直肠黏膜下肿瘤临床病理学特征分析(附559例报告)

摘要

Objective To analyze the tumors location and pathological characteristics of colorectal submucosal tumors (SMTs). Methods Clinicopathological data of 559 colorectal SMTs in our department from January 2008 to December 2014 were retrospectively analyzed. Results In colonic SMTs, 148 cases lipomas (84.09%) are the most common tumors, followed by 9 cases granular cell tumors (GCTs) (5.11%), 7 cases leiomyomas(3.98%), 7 cases neuroendocrine tumors (NETs) (3.98%). 1 case gastrointestinal stromal tumors (GISTs) (1.83%) and 4 cases other tumors(2.27%). In those cases, lipomas and GCTs were common located in the right hemicolon. Leiomyomas and NETs were common located in the left hemicolon. In rectal cases, 349 cases NETs (91.12%) are the most common tumors, followed by 13 cases lipomas(3.39%), 11 cases leiomyomas(2.97%), 7 cases GISTs(1.83%), 1 case GCTs(0.26%) and 2 cases other tumors(0.52%). In those cases, NETs were common located in the lower rectum. Lipomas and leiomyomas were common located in the upper and lower rectum. GISTs were common located in all parts of rectum. Conclusion The colonic SMTs usually were benign lesions, so they could be intervened delayed, and be arranged for routine following-up. However, the rectal SMTs usually had malignant tendency, the active treatment and enforced follow-up were the key to improve the prognosis of the rectal SMTs.%目的 探讨结直肠黏膜下肿瘤(SMTs)的分布情况及临床病理学特征.方法 回顾性分析2008年1月至2014年12月,复旦大学附属中山医院内镜中心行结肠镜下诊治结直肠SMTs 559例临床资料、病理学类型及其特点.结果 结肠SMTs中以脂肪瘤148例(84.1%)最为常见,其次为颗粒细胞瘤(GCTs)9例(5.1%),平滑肌瘤7例(4.0%),神经内分泌肿瘤(NETs)7例(4.0%),胃肠间质瘤(GISTs)1例(0.6%)及其他SMTs4例(2.3%).其中脂肪瘤可发生于结肠各段,以右半结肠多见;GCTs多见于右半结肠;平滑肌瘤、NETs多见于左半结肠.直肠SMTs中以NETs349例(91.1%)最为常见,其次为脂肪瘤13例(3.4%),平滑肌瘤11例(2.9%),GISTs7例(1.8%),GCTs1例(0.3%)及其他SMTs2例(0.5%).其中NETs可发生于直肠各段,以下段直肠多见;脂肪瘤、平滑肌瘤多见于直肠上下段;GISTs可见于直肠各段.结论 结肠SMTs中良性病变多,可允许内镜下随访,当出现临床症状或瘤体短时间内增大时行内镜下治疗.直肠SMTs中有恶变倾向的病变占绝大多数,一经发现需积极治疗.