Bromberg S H, Zampieri J C, Cavalcanti L A, Waisberg J, Barreto E, de Godoy A C
Serviço de Gastroenterologia Cirúrgica, Hospital do Servidor Público Estadual Francisco Morato de Oliveira, São Paulo.
Rev Assoc Med Bras (1992). 1997 Oct-Dec;43(4):319-25. doi: 10.1590/s0104-42301997000400008.
To evaluate the incidence of colorectal lipomas, its diagnostic methodology and therapeutic management.
The reviewed necropsies performed in a six years period and the patients' records from colorectal lipomas cases treated up to 1965 until 1993 were studied enhancing the clinical presentation, their diagnosis and therapy. The 29 cases of submucosal intestinal lipomas were disposed in three groups. The first group with ten patients lipomas were detected at necropsies. The second group with 11 symptomatic patients and group three with 8 asymptomatic patients which lipomas were discovered accidentally in surgical specimens resected due to neoplasm or in the course of diagnostical procedure.
0.56% of patients who were submitted to necropsy disclosed colorectal lipomas situated preferentially in right colon and in female. Enterourhage was the most often symptom (54.5%) in the group two, followed by cramp abdominal pain. Intussusception appeared in three patients (27.3%). Contrary to the medical literature, the symptomatic lipomas were preferentially situated in left colon and its mean size was 6.1 cm. The diagnosis were performed through opaque enema and more recently by colofibroscopy and CT scan. Resections were performed in all patients: five were enlarged, three were local and other three were endoscopic resections. Multiple lipomas were detected in 30% of patients who were submitted to necropsy and in 25% of asymptomatic group. In both groups no tumor was larger than 2.0 cm of diameter.
Colorectal lipomas are rare in both clinical presentation and necropsy. Before the advent of CT scan and colofibroscopy the majority of the patients were submitted to wide resections, in the assumption of malignancy. Afterwards the endoscopic polipectomy and local resection became our preferential management.
评估结直肠脂肪瘤的发病率、诊断方法及治疗手段。
研究了六年期间进行的尸检以及1965年至1993年期间接受治疗的结直肠脂肪瘤患者的病历，以强化临床表现、诊断及治疗情况。29例黏膜下肠脂肪瘤患者分为三组。第一组10例患者的脂肪瘤在尸检时被发现。第二组11例有症状患者，第三组8例无症状患者，其脂肪瘤在因肿瘤切除的手术标本中或诊断过程中意外发现。
接受尸检的患者中0.56%被发现有结直肠脂肪瘤，这些脂肪瘤多位于右半结肠且以女性居多。在第二组中，肠套叠是最常见的症状（54.5%），其次是腹部绞痛。有3例患者出现肠套叠（27.3%）。与医学文献相反，有症状的脂肪瘤多位于左半结肠，平均大小为6.1厘米。诊断通过钡剂灌肠进行，最近则采用结肠镜检查和CT扫描。所有患者均接受了切除手术：5例为扩大切除，3例为局部切除，另3例为内镜下切除。在接受尸检的患者中，30%检测到多发脂肪瘤，无症状组中这一比例为25%。两组中均无直径大于2.0厘米的肿瘤。
结直肠脂肪瘤在临床表现和尸检中均较为罕见。在CT扫描和结肠镜检查出现之前，大多数患者因怀疑恶性肿瘤而接受广泛切除。此后，内镜下息肉切除术和局部切除成为我们首选的治疗方法。
