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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。
Objective To investigate the distribution and clinicopathological features of colorectal submucosal tumors (SMTs). Methods From January 2008 to December 2014, the clinical data, pathological types and characteristics of 559 cases of colorectal SMTs underwent colonoscopy at Zhongshan Hospital of Fudan University were analyzed retrospectively. Results The majority of lipomas were found in colon SMTs (84.1%), followed by 9 (5. 1%) with granular cell tumor (GCTs), 7 (4.0%) with leiomyoma, 7 with NETs 4.0%), gastrointestinal stromal tumors (GISTs) in 1 case (0.6%) and other SMTs in 4 cases (2.3%). One lipoma can occur in the colon sections, more common in the right colon; GCTs more common in the right colon; leiomyoma, NETs more common in the left colon. Among the rectal SMTs, NETs were the most common in 349 cases (91.1%) followed by lipoma in 13 cases (3.4%), leiomyoma in 11 cases (2.9%), GISTs in 7 cases (1.8%), GCTs in 1 case Example (0.5%). NETs can occur in the rectum, the following rectal more common; lipoma, leiomyoma more common in the upper and lower rectum; GISTs can be seen in the rectum. Conclusion There are many benign lesions in the colon SMTs, which can be followed up by endoscopy. When clinical symptoms or tumor enlargement occur within a short time, endoscopic treatment is performed. Rectal SMTs malignant tendency of the disease accounted for the vast majority, once found to be actively treated.