结直肠早癌的诊断及治疗课件

1、Diagnosis and Treatment of Early Colorectal Cancer（结直肠早癌的诊断及治疗）Ling Tingsheng（凌亭生）Chapter 1 （第一章）Morphology of colorectal tumor（结直肠早癌的形态）Morphology of superficial colorectal early cancer（浅表结直肠早癌的形态）Gross configuration of colorectal neoplasm（结直肠增生的基本形态）（分别是：凹陷、平坦、隆起型）s+c Massive invasion（浸润多）Small in

2、vasion（浸润少）c+aa+cs+cDepression in different modality（不同凹陷的形态）Lateral spreading tumor（侧方生长的分型（G/NG分型）Serrated lesion（锯齿状病灶）Chapter 2 （第二章）Invasive Depth of Early Colorectal Cancer（早期结直肠早癌的浸润深度）Measurement of invasive depth（浸润深度的评估方法）For case with stalk（带蒂病灶）Measurement of invasive depth（浸润深度的评估方法）Mus

3、cularis mucosa clear（黏膜肌层完整）Muscularis mucosa unclear（黏膜肌层不完整） For superficial cases（浅表病灶） Case 1Case 2Case 3Case 4Case 5Definition of early colorectal cancer（结直肠早癌的定义）Early colorectal cancer means adenocarcinoma whose invasive depth is not deeper than submucosal layer no matter lymph node is involv

4、ed or not.（腺瘤细胞浸润深度不超过黏膜下层，无论是否有淋巴结累及）Submucosal layer is divided into three sheets equally and named as sm1, sm2, and sm3 respectively.（黏膜下层分3层：分别sm123）Invasive depth is defined as sm1(2000um)(各自的深度划分)Chapter 3（第三章）Diagnosis of Invasive Depth By WLE and chromo-endoscopy（白光及染色内镜检查以判断浸润深度的方法）Size and

5、 Invasive depth（病灶大小与浸润深度的关系）No matter what size is the lesion, even a lesion over 10 cm is probable a intramucosal tumor.（然而病灶大小与深度并非完全成正比，超过10cm的病灶亦有可能为黏膜内癌）To evaluate invasive depth, finding signs of submucosal invasion is the right way, then verifying by ME and NBI.（先明确黏膜下浸润的征象，然后借助放大内镜和NBI证实）C

6、ompare the WLE pictures and pathological low power views of the specimen once and again, then you will make it.（临床实践：反复比较白光及内镜病理图像）A large intramucosal adenocarcinoma小但是浸润深的病灶留心Signs of invasive colorectal tumor（进展期结直肠癌的表现）Signs of sm invasion for type tumor（I型肿瘤的浸润征象）sign 1 expanded change, uneven

7、color （张力大，颜色不均） A case with expanded change（张力大表现）sign 2 disappearance of lobulation （腺管开口消失）sign 3 Depression on the surface of polypoid（息肉表面塌陷） （黏膜肌层完整）sign 4 Budding on the top of polypoid（息肉顶端“新发芽”形态） Signs of sm invasion for type tumor（II型肿瘤的浸润征象）sign 1 Depressed area on the surface（表面塌陷）sign

8、2 Fold convergence and combination（皱襞汇聚及融合）sign 3 Nodules in depressed area（凹陷区域有结节）sign 4 Strong reddish（强红征）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.（深凹陷举例）1/2 ，为深Sm癌，3为浅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.（皱襞汇集举例）1：为Ng/LST，深Sm癌，2：深Sm癌，3：Ng/LSt，浅凹陷癌）Deep depression. (1 and 2) IIc, SM deep cancer; and (3) IIc, SM superficial cancer.（深凹陷举例）1/2：深Sm癌，3：浅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.（黏膜白斑举例）1：深Sm癌，2：浅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.（强红征举例）1：浅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.（张力高举例）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.（僵硬病灶举例）1/2：深Sm癌，3：深Sm癌Irregular surface. (1-3) Is, SM deep cancer.（表面不规则举例）1/2/3：深Sm癌Loss of lobulation. (1-3) Is, SM deep cancer.（腺管开口消失举例）均为深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.（粗蒂举例）（1：蒂部累及，2：头部累及，3：蒂部累及）Value of sm invasion signs（Sm浸润征象的作用）Case discussion 1（病例讨论）M cancer , Morphology changes due to air volume (inflate or deflate)(黏膜内癌，根

13、据肠镜充气量的多少，形态发生改变)Case discussion 2SM cancer： expanded change and depression on the surface of sp lesion（Sm癌，I型病灶：表面张力高，表面凹陷）Case discussion 3SM cancer： expanded change and deep depression on the surface of sp lesion（Sm癌，I型病灶张力高，表面深凹陷）Case discussion 4 SM cancer： expanded change of 0-sp lesion（Sm癌，0-

14、I型病灶高张力改变）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，黏膜纠集)Chapter 4（第四章）Diagnosis of Invasive Depth By ME an

15、d chromoendoscopy（放大内镜及染色内镜判断浸润深度的方法）Indigo-carmine and crystal violet（靛胭脂和结晶紫）Indigo-carmine is very useful for improve detection rate of small lesions in stomach and colorectum.（靛胭脂有助于发现小病灶）Indigo-carmine is helpful for confirm WLE morphology type for a colorectal tumor.（靛胭脂有助于白光内镜判断结直肠肿瘤的形态）Cryst

16、al violet staining is the gold standard modality for classifying pit pattern.（结晶紫染色是确定Pit分型的金标准）Technique for Pit pattern observation（Pit分型的观察技巧）pictures of crystal violet staining（结晶紫染色图片）Pit pattern classification（pit分型）Vi pit pattern-low grade irregularity（Vi分型：低度不规则）Vi pit pattern-high grade irr

17、egularity（Vi分型：高度不规则）Coexisting of different pit patterns（不同类型Pit共存）Pit pattern and Pathology: data（pit分型及病理结果）Pit pattern and Pathology: data（pit分型及病理结果） A case（病例）Adenocarcinoma, tub1, SM 2250um, ly0, V1Am J Gastroenterology 2008;103:27002706文献标题（放大染色内镜在判断早期肿瘤浸润深度的作用）Pit pattern and invasionPit pattern and invasive depth（Pit分型和浸润深度）Characteristics of Lesions Diagnosed by Magnifying Chromoendoscopy（放大色素内镜下早癌病灶的形态）Clinicopathologic Characteristics of Lesions Diagnosed by Magnifying chromoendoscopy（临床及病理征象）Diagnostic Sensitivity and