結(jié)直腸早癌的診斷及治療課件

1、Diagnosis and Treatment of Early Colorectal Cancer（結(jié)直腸早癌的診斷及治療）Ling Tingsheng（凌亭生）Chapter 1 （第一章）Morphology of colorectal tumor（結(jié)直腸早癌的形態(tài)）Morphology of superficial colorectal early cancer（淺表結(jié)直腸早癌的形態(tài)）Gross configuration of colorectal neoplasm（結(jié)直腸增生的基本形態(tài)）（分別是：凹陷、平坦、隆起型）s+c Massive invasion（浸潤多）Small in

2、vasion（浸潤少）c+aa+cs+cDepression in different modality（不同凹陷的形態(tài)）Lateral spreading tumor（側(cè)方生長的分型（G/NG分型）Serrated lesion（鋸齒狀病灶）Chapter 2 （第二章）Invasive Depth of Early Colorectal Cancer（早期結(jié)直腸早癌的浸潤深度）Measurement of invasive depth（浸潤深度的評估方法）For case with stalk（帶蒂病灶）Measurement of invasive depth（浸潤深度的評估方法）Mus

3、cularis mucosa clear（黏膜肌層完整）Muscularis mucosa unclear（黏膜肌層不完整） For superficial cases（淺表病灶） Case 1Case 2Case 3Case 4Case 5Definition of early colorectal cancer（結(jié)直腸早癌的定義）Early colorectal cancer means adenocarcinoma whose invasive depth is not deeper than submucosal layer no matter lymph node is involv

4、ed or not.（腺瘤細(xì)胞浸潤深度不超過黏膜下層，無論是否有淋巴結(jié)累及）Submucosal layer is divided into three sheets equally and named as sm1, sm2, and sm3 respectively.（黏膜下層分3層：分別sm123）Invasive depth is defined as sm1(2000um)(各自的深度劃分)Chapter 3（第三章）Diagnosis of Invasive Depth By WLE and chromo-endoscopy（白光及染色內(nèi)鏡檢查以判斷浸潤深度的方法）Size and

5、 Invasive depth（病灶大小與浸潤深度的關(guān)系）No matter what size is the lesion, even a lesion over 10 cm is probable a intramucosal tumor.（然而病灶大小與深度并非完全成正比，超過10cm的病灶亦有可能為黏膜內(nèi)癌）To evaluate invasive depth, finding signs of submucosal invasion is the right way, then verifying by ME and NBI.（先明確黏膜下浸潤的征象，然后借助放大內(nèi)鏡和NBI證實(shí)）C

6、ompare the WLE pictures and pathological low power views of the specimen once and again, then you will make it.（臨床實(shí)踐：反復(fù)比較白光及內(nèi)鏡病理圖像）A large intramucosal adenocarcinoma小但是浸潤深的病灶留心Signs of invasive colorectal tumor（進(jìn)展期結(jié)直腸癌的表現(xiàn)）Signs of sm invasion for type tumor（I型腫瘤的浸潤征象）sign 1 expanded change, uneven

7、color （張力大，顏色不均） A case with expanded change（張力大表現(xiàn)）sign 2 disappearance of lobulation （腺管開口消失）sign 3 Depression on the surface of polypoid（息肉表面塌陷） （黏膜肌層完整）sign 4 Budding on the top of polypoid（息肉頂端“新發(fā)芽”形態(tài)） Signs of sm invasion for type tumor（II型腫瘤的浸潤征象）sign 1 Depressed area on the surface（表面塌陷）sign

8、2 Fold convergence and combination（皺襞匯聚及融合）sign 3 Nodules in depressed area（凹陷區(qū)域有結(jié)節(jié)）sign 4 Strong reddish（強(qiáng)紅征）sign 5 hardness（硬度）sign 6 Elevation of lesion base（病灶基底抬高）Deep depression. (1 and 2) IIc, SM deep cancer; and (3) IIc, SM superficial cancer.（深凹陷舉例）1/2 ，為深Sm癌，3為淺Sm癌）Fold convergence. (1) II

9、a IIc (LST-NG), SM deep cancer; (2) Is IIc, SM deep cancer; and (3) IIa IIc (LST-NG), SM superficial cancer.（皺襞匯集舉例）1：為Ng/LST，深Sm癌，2：深Sm癌，3：Ng/LSt，淺凹陷癌）Deep depression. (1 and 2) IIc, SM deep cancer; and (3) IIc, SM superficial cancer.（深凹陷舉例）1/2：深Sm癌，3：淺Sm癌White spots (chicken skin appearance). (1)

10、IIa IIc (LST-NG), SM deep cancer; (2) Is, SM deep cancer; and (3) IIa IIc, SM deep cancer.（黏膜白斑舉例）1：深Sm癌，2：淺Sm癌，3：深Sm癌Redness (reddened area). (1) IIc (LST-NG), SM superficial cancer; (2) Is, SM deep cancer; and (3) IIa IIc, SM deep cancer.（強(qiáng)紅征舉例）1：淺sm癌，2：深Sm癌，3.深Sm癌Expansion. (1) Is, SM deep cancer

11、; and (2 and 3) Is IIc, SM deep cancer.（張力高舉例）1：深Sm癌，2/3:深sm癌Firm consistency. (1 and 2) Is, SM deep cancer; and (3) IIa IIc, SM deep cancer.（僵硬病灶舉例）1/2：深Sm癌，3：深Sm癌Irregular surface. (1-3) Is, SM deep cancer.（表面不規(guī)則舉例）1/2/3：深Sm癌Loss of lobulation. (1-3) Is, SM deep cancer.（腺管開口消失舉例）均為深Sm癌Thick stalk.

12、 (1) Ip, SM deep (stalk invasion) cancer; (2) Ip, SM superficial (head invasion) cancer; and (3) Ip IIc, SM deep (stalk invasion) cancer.（粗蒂舉例）（1：蒂部累及，2：頭部累及，3：蒂部累及）Value of sm invasion signs（Sm浸潤征象的作用）Case discussion 1（病例討論）M cancer , Morphology changes due to air volume (inflate or deflate)(黏膜內(nèi)癌，根

13、據(jù)腸鏡充氣量的多少，形態(tài)發(fā)生改變)Case discussion 2SM cancer： expanded change and depression on the surface of sp lesion（Sm癌，I型病灶：表面張力高，表面凹陷）Case discussion 3SM cancer： expanded change and deep depression on the surface of sp lesion（Sm癌，I型病灶張力高，表面深凹陷）Case discussion 4 SM cancer： expanded change of 0-sp lesion（Sm癌，0-

14、I型病灶高張力改變）Case discussion 5 SM cancer： depression on the surface of p lesion(p +c)（Sm癌，Ip型病灶表面凹陷）Case discussion 6 SM cancer： hardness of p lesion（Sm癌，Ip型：硬度高）Case discussion 7 SM cancer： elevation of lesion base and fold convergence(Sm癌，病灶基底抬高，黏膜糾集)Chapter 4（第四章）Diagnosis of Invasive Depth By ME an

15、d chromoendoscopy（放大內(nèi)鏡及染色內(nèi)鏡判斷浸潤深度的方法）Indigo-carmine and crystal violet（靛胭脂和結(jié)晶紫）Indigo-carmine is very useful for improve detection rate of small lesions in stomach and colorectum.（靛胭脂有助于發(fā)現(xiàn)小病灶）Indigo-carmine is helpful for confirm WLE morphology type for a colorectal tumor.（靛胭脂有助于白光內(nèi)鏡判斷結(jié)直腸腫瘤的形態(tài)）Cryst

16、al violet staining is the gold standard modality for classifying pit pattern.（結(jié)晶紫染色是確定Pit分型的金標(biāo)準(zhǔn)）Technique for Pit pattern observation（Pit分型的觀察技巧）pictures of crystal violet staining（結(jié)晶紫染色圖片）Pit pattern classification（pit分型）Vi pit pattern-low grade irregularity（Vi分型：低度不規(guī)則）Vi pit pattern-high grade irr

17、egularity（Vi分型：高度不規(guī)則）Coexisting of different pit patterns（不同類型Pit共存）Pit pattern and Pathology: data（pit分型及病理結(jié)果）Pit pattern and Pathology: data（pit分型及病理結(jié)果） A case（病例）Adenocarcinoma, tub1, SM 2250um, ly0, V1Am J Gastroenterology 2008;103:27002706文獻(xiàn)標(biāo)題（放大染色內(nèi)鏡在判斷早期腫瘤浸潤深度的作用）Pit pattern and invasionPit pattern and invasive depth（Pit分型和浸潤深度）Characteristics of Lesions Diagnosed by Magnifying Chromoendoscopy（放大色素內(nèi)鏡下早癌病灶的形態(tài)）Clinicopathologic Characteristics of Lesions Diagnosed by Magnifying chromoendoscopy（臨床及病理征象）Diagnostic Sensitivity and