2015 20 6 345 2014 * colorectal cancer CRC 25 2000 14 WHO 20% 1 WHO 6 5 70% 5 2. low-grade 12% 2 intraepithelial neoplasia LGIN 5 90% 2 high-grade intraepithelial neoplasia HGIN 3. traditional serrated adenoma TSA 2010 3 / sessile serrated adenoma / 4 polyps SSA /P 5 7 6 1-2 a > 10 mm b c 1. DOI 10. 3969 /j. issn. 1008-7125. 2015. 06. 006 * Email zhsli @ 81890. net Email wangguiq@ 126. com Email drjiang@ 163. com IBD 5 3 1975 SSA /P TSA 8 SSA /P TSA 9 SSA /P 4. laterally spreading tumor LST 10 mm
346 Chin J Gastroenterol 2015 Vol. 20 No. 6 10 LST 5. en bloc resection 6. / 2 mm 1 7. complete resection /R0 resection 8. curative resection 9. / local recurrence /residual 1 2 3 11 2 / 6 2009 1 11 10. interval colorectal cancer post-colonoscopy colorectal cancer PCCRC 12 2009 29. 44 /10 3 14. 23 /10 2009 13 1 ~ 4 1. 2 ~ 1. 3 65% 2 2009 4 40 85 2009
2015 20 6 347 1. 2% 3. 6% 40. 0% 14. 4% 77. 9% 14 4. 18% ~ 20% 1 1 5 44% 25 36% ~ 63% 15 1 26 5 47. 2% 5 > 50% 2 < 40% 16 1. 27 > 50 38% 27 3 17 BMI 5 19% RR 1. 19 1. 28 40 5. 2 2 80 197. 4 /10 27% 18 20% 29 2. meta 2. 24 3. 97 50 30 1 1. 8% 3. 4% 6. 9% 19 20 2. 33 4. 5 40 21 3. IBD 20% IBD 10 2 ~ 4 22 meta UC 14 31-33 34 2. 4 95% CI 2. 1 ~ 2. 7 23 24 10 20 30 UC 2014
348 Chin J Gastroenterol 2015 Vol. 20 No. 6 35 36 37 BMI 4 1 3 ~ 6 0 ~ 2 Septin 9 1 37 50 ~ 55 0 56 ~ 75 1 0 1 0 1 0 1 BMI < 25 kg /m 2 0 25 kg /m 2 1 0 1 1. 1 2 ~ 3 1 50 ~ 75 2 FOBT 3 UC CD 3 1 2 3 hereditary nonpolyposis colorectal cancer HNPCC Lynch 2 38 2. HNPCC MLH1 MSH2 SM1 20 ~ 25 1 /3 SM2 1 /3 SM3 2 ~ 5 25 1 ~ 2 1 /3 35 41 SM1 < 1 000 μm 39 MSH6 42 PMS2 43 3. 25 ~ 30 2 ~ 3 1998 40 ~ 50 1 ~ 2 40 2 2 1 / 2 / 3 * 4. 1 / 4. 2 * 4. 3 4. 4 * 5 * 50 50 50 75 75 40% ~ 50% 30 44
2015 20 6 349 ifobt 48 APC familial adenomatous polyposis FAP 2. Septin 9 FAP attenuated FAP AFAP Gardner Turcot Septin 9 APC APC Septin 9 10 ~ 12 1 ~ 2 79. 3% ~ 95. 6% AFAP 84. 8% ~ 99% 49 18 ~ 20 25 ~ 30 74. 8% 87. 4% ifobt 50 Septin 9 MUTYH MUTYH-associated poly- AFAP 55 AFAP 18 ~ 20 posis MAP CCE 52 - Peutz-Jeghers syndrome PJS 18 2 ~ 3 DNA juvenile polyposis JPS 15 2 ~ 3 1 FOBT gfobt CFDA 74. 8% 97. 5% 3. 51 53 microrna 4. 54-55 1. FOBT 56 37. 9% 42. 4% 57 45 gfobt 5. 46 FOBT 47 2 FOBT ifobtgfobt 5 3 FOBT gfobt 1.
350 Chin J Gastroenterol 2015 Vol. 20 No. 6 2 ~ 3 L PEG PEG 6 min 60 PEG PEG SF-PEG 3. 1 24 h 1 4 h 6 h 1 ~ 2 2 5 2. 1 d Kudo 6 61 3. 24 h 3. 4. 4. narrow band imag- ing NBI Fuji intelligent chromoendoscopy FICE I-Scan 58-59 1. 2. 100 ~ 150 1. 3 62 2. 90% 85% 63 NBI
2015 20 6 351 NBI Sano CLE narrow-band imaging 64-65 international colorectal endoscopic classification NICE AFI FICE I-Scan NBI 6. autofluorescence imaging 7. blue laser imaging BLI 5. confocal laser endomicroscopy CLE 1 000 BLI CLE NBI CLE 66 Ⅰ pit Ⅱ pit TSA SSA /P Ⅲ S Ⅱc pit pit Ⅲ L pit pit Ⅳ pit Ⅳ B pit Ⅳ V Ⅴ I Ⅲ S Ⅲ L Ⅳ pit Ⅴ N pit 6 61 pit pattern
352 Chin J Gastroenterol 2015 Vol. 20 No. 6 35 1. > 85% CLE 70 39 67 7 1. 24% 72 2. Ottawa Aronchick 1 ~ 2 2. > 95% 95% 2 ~ 4 80% 73 3. < 6 min 68 > 6 min NBI 28. 3% 11. 8% 9 min 74 endoscopic submucosal dissection ESD 6 min 75-76 69 4. adenoma detection rate ADR 71 5 40% < 5 50 ADR > 20% > 25% > 15% 77 7 2005 39
2015 20 6 353 ADR 1 000 μm 88 ADR 1. 0% 3. 0% 4. endoscopic ultrasound EUS ADR > 33. 5% EUS EUS mini-probe EUS 78 ADR 79 meus endorectal ultrasound ERUS meus T1 5. < 1 < 1% ERUS T CT MRI 92 EUS N 80 93 81 82 5. CT 95% T 67% N CT MRI 6. MRI 92 95 7. PET-CT 83 CT NBI MRI PET-CT 96 1. 0-Ⅱa 0-Ⅱb LST 0-Ⅱc LST < 2% 0-Ⅱc LST NBI > 36% 0-Ⅱc > 1 cm > 70% 67 LST CT meus 10 mm ERUS MRI 84 LST 30% PET-CT 2. 85 Ⅴ Ⅴ I 5 Ⅴ I Ⅴ I Ⅴ N 90% 97-99 Ⅴ I < 1 000 μm Ⅴ N > 1 000 μm 86 3. NBI NICE 1 87 Ⅴ I 89-90 N 12 MHz meus 91 69% 94 NICE 8 NBI NICE 2 endoscopic NICE 3 mucosal resection EMR ESD
354 Chin J Gastroenterol 2015 Vol. 20 No. 6 c Tis T1 TNM T M SM 2 3 8 4 1. 5 > 5 mm > 1 cm ESD 10 EMR 100 ESD ESD 101 120 min 112 150 min 113 113 ESD 113-114 2 2. EMR 1 113 4 ESD 2 88. 0% ~ 98. 3% - 89. 0% ~ 92. 0% 97 115-116 ESD - 67. 1% ~ 78. 6% 62. 4% ~ 74. 0% 117-118 ESD 2 ~ 5 cm endoscopic piecemeal mucosal resection EPMR EMR > 2 cm 85. 5% ~ 98. 3% 83. 3% ~ 97. 6% ESD / 119 102 EMR EMR 9 3 EMR plasma coagulation APC photodynamic 85% 68. 6% ~ 86% 103-104 20 mm 19. 9% ~ 30. 7% 105-106 EMR 71. 7% ~ 87. 4% 70. 6% ~ 91. 7% 107-108 > 90% 109-110 3. ESD 1 EMR IT Dual Hook 111 2 1 SSA /P 3 ESD 4 cm 112 5 cm 113 ESD 120 4. argon therapy PDT
2015 20 6 355 A Is B C D 9 EMR A LST B C D 10 ESD 2 3 ESD ESD ESD EMR 20 mm EMR EPMR 1 20 ~ 30 mm LST- 3 4 1. 121 58 122 ESD CO 2 2. 1 1LST- 2LST- > 30 mm 5 5 ~ 7 d 5 mm Ⅰ EMR 1 5 ~ 20 mm 2 > 10 mm Is SSA /P 3 EPMR 10 mm 2 ESD > 30 mm LST EPMR / ESD 1 > 20 mm EMR > 20 mm 3Ⅴ I 4 6 2 3 UC 4
356 Chin J Gastroenterol 2015 Vol. 20 No. 6 4 2 1 2 ASA Ⅲ 3 4 1 2 HNPCC 3 4 5 1 2 UC 3 4 1 ESD 5 72 h 69 3 + 1 000 μm 2 3 123-124 98-99 < 1 000 μm 11 1. 5 EMR ESD % % % % % Yoshida 125 2013 624 EMR 93. 3 78. 3 0 1. 1 / 126 2007 602 EMR / 97. 7 0 3. 7 0 Hurlstone 127 2004 599 EMR / 96. 0 0. 2 2. 0 / Moss 128 2011 479 EMR / 89. 2 1. 3 2. 9 20. 4 * Buchner 129 2012 315 EMR 53. 5 91. 0 0 10. 8 27. 0 * Park 104 2011 236 EMR 85. 2 68. 6 1. 3 8. 0 0. 8 Saito 115 2010 1111 ESD 88. 0 89. 0 4. 9 1. 5 / Lee 97 2013 1000 ESD 97. 5 91. 2 5. 3 0. 4 0. 4 116 2012 174 ESD 98. 3 92. 0 2. 9 3. 4 0. 6 Tseng 130 2013 92 ESD 90. 2 89. 1 12. 0 0. 0 / Farhat 131 2011 85 ESD 67. 1 62. 4 27. 1 9. 4 / Hurlstone 132 2007 42 ESD 78. 6 74. 0 2. 4 11. 9 19. 0 EMR EPMR / * /
2015 20 6 357 2 144 48 h 133 p 11 EMR 150 1. 8% ~ 18% 127 134 0. 2% ~ 7. 2% 106 127 129 ESD 0 ~ 3. 6% 135-136 2. CT EMR <1.5% 104 128 ESD 0. 8% ~20. 4% 146-147 ESD 2. 9% ~ 14. 5% 116 138-139 141 148-149 EMR ESD LST ESD 97 146 CO 2 EMR 0-Ⅱa + Ⅰs 10 mm > 90% 151 OTSC over-the-scope clip 152 105-106 ESD 137 EMR 1. 0% ~ 3. 1% 109 126 0. 6% ~ 3. 0% 109-110 ESD 0 ~ 15. 6% 138-139 4 h 1. 4% ~ 12. 5% 140-141 > 20 mm EMR 142 3. 659 ESD 10 143 0. 003% ~ 0. 1% 153 ESD 154 ESD ESD > 30 mm APC 144 155 APC 145 EMR 1. EMR 0. 8% ~ 7. 2% 103-104 134 156 EMR EPMR
358 Chin J Gastroenterol 2015 Vol. 20 No. 6 / 20. 4% ~ 27% 128-129 meta EMR 15% 20% 3% 11 102 ESD 0 ~ 2. 0% 97 157-158 EMR ESD OR 0. 09 159 EMR 0 ~ 3. 2% 110 142 ESD 0 ~ 4. 9% 116 138 140 Kwong 2. Ming Fock NBI 160 APC 3. 6 12 1 1 3 ~ 6 161 / / 6 6 / William Tam Lyell McEwin 3 ~ 5 < 10 mm 2 ~ 3 1 ~ 2 < 10 mm 1 ~ 3 3 ~ 10 1 ~ 2 > 10 1 1 > 10 mm 1 ~ 2 1 1 ~ 2 1 ~ 2 < 10 mm 2 ~ 3 10 mm 1 ~ 2 TSA 1 6 61 Elsevier WHO 2010 3 > 20 1 International Agency for Research On Cancer. World Health 1 Organization. GLOBOCAN 2012 Estimated Cancer 5 2 2 Incidence Mortality and Prevalence Worldwide in 2012 > 10 mm 2 EB /OL 2014-12-15. http / /globocan. iarc. fr /
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