目的：对大肠侧向发育型肿瘤(colorectal laterally spreading tumor,LST)患者的临床、内镜、病理资料进行回顾性分析,进一步了解相关癌变因素。方法：我院确诊LST病灶100处,患者92例,确认病变部位、大小、内镜下形态学分型,通过放大内镜联合窄带成像技术(Narrow Band Imaging,NBI)确认腺管开口类型,判断病理类型,评估浸润深度。结果：100处LST,颗粒型LST共55例,非颗粒型LST共45例,其中扁平隆起型相对多(34%),直肠为主要发病部位(36%)；病理回报为低级别管状腺瘤占37%,其次为高级别上皮内瘤变,占比25%；腺管开口分型,颗粒型主要以Ⅳ型最多,非颗粒型的扁平隆起型以Ⅲ型为主；31例恶变的病灶,结节混合型最多,直肠多发且以≥40mm为主,腺管分型V型最多。结论：LST内镜下表现多样化,根据内镜形态及腺管开口类型,实时判断组织病理学及浸润深度,对于结节混合型及假凹陷型,需格外重视其恶性潜能及侵袭性。

Objective: We analyzed retrospectively the clinical manifestations, endoscopic features and clinicopathological types of patients with colorectal laterally spreading tumors(LST),found the related factors of carcinogenesis.Methods:We diagnosed 92 patients with 100 lesions of LST in our hospital,According to the diagnosis of the location, size, endoscopic morphological classification and the pit pattern by Narrow Band Imaging (NBI), we judged the pathological type and estimated depth of invasion.Results: Among the 100 lesions of LST, there were 55 cases of granular type and 45 cases of non-granular type, of which non-granular flat elevated type was relatively more (34%). The rectum is the main site of LST (36%). Among the pathological types,low-grade tubular adenomas account for 37%, followed by high-grade intramucosal neoplasia (25%).The pit pattern is type Ⅳ in the most granular type, and the most flat elevate type is type Ⅲ;granular nodular mixed type is the most common in 31 cases of malignant lesions; LST occurs frequently in the rectum and is dominated by≥40mm, and the type V pit pattern is the most.Conclusion:The endoscopic manifestations of LST are diversified,According to the endoscopic morphology and pit pattern, the histopathology and depth of invasion were judged in real time. Granular nodular mixed type and non-granular pseudo-depressed type should pay attention to their malignant potential and invasiveness.

(2017MS08115)