Blackstone M O, Riddell R H, Rogers B H, Levin B
Gastroenterology. 1981 Feb;80(2):366-74.
In performing colonoscopy over a 4-yr period on 112 patients with long-standing ulcerative colitis, a dysplasia-associated lesion or mass (DALM) was found in 12. This appeared as either a single polypoid mass (5 cases), a plaquelike lesion (2 cases), or multiple polyps (5 cases). In 7 of these 12 cases carcinoma was subsequently found. This was particularly true in the 5 cases of single polypoid masses where all 5 contained invasive carcinoma. In none of the cases associated with malignancy did multiple biopsies of the DALM reveal invasive carcinoma. In only 2 of the 7 patients with carcinoma was the dysplasia "severe," being "mild" or "moderate" in the remaining 5. In the 27 patients with dysplasia found incidentally in random biopsies of flat mucosa only one carcinoma was found, in contrast to the 7 cancers in 12 patients with DALM. This difference leads us to regard the finding of DALM, especially a single polypoid mass, as highly significant in patients with long-standing ulcerative colitis. It carries a sufficiently high risk of cancer, thereby constituting a strong indication for colectomy.
在4年期间，对112例长期溃疡性结肠炎患者进行了结肠镜检查，其中12例发现了发育异常相关病变或肿物（DALM）。其表现为单个息肉样肿物（5例）、斑块样病变（2例）或多个息肉（5例）。在这12例中的7例随后发现了癌。在5例单个息肉样肿物的病例中尤其如此，所有5例均含有浸润性癌。在与恶性肿瘤相关的病例中，对DALM进行多次活检均未发现浸润性癌。在7例癌患者中，只有2例发育异常为“重度”，其余5例为“轻度”或“中度”。在27例在平坦黏膜随机活检中偶然发现发育异常的患者中，仅发现1例癌，而12例有DALM的患者中有7例癌。这种差异使我们认为，在长期溃疡性结肠炎患者中，发现DALM，尤其是单个息肉样肿物，具有高度的重要性。它具有足够高的癌变风险，因此构成结肠切除术的有力指征。
