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内镜黏膜下剥离术治疗大肠侧向发育型肿瘤的探讨

(2014-10-22 12:24:42)

    [摘要]

    目的  探讨内镜黏膜下剥离术(ESD)治疗大肠侧向发育型肿瘤(LST)的临床价值。

    方法  对肠镜检查诊断为LST且直径>2 cm32处病变进行ESD治疗,回顾性分析病变特征(大小)以及手术结果(一次性完整切除率、手术时间、并发症、病理诊断、随访情况等)。

    结果  32处大肠LST,肿瘤直径2.58.0 cm,平均(4.1±2.1cm 29例(90.6%)一次性完整切除。ESD手术时间25300 min,平均(75.7±66.0 min。术中5例(15.6%)出现动脉血管出血,行止血夹或电凝成功止血;迟发性出血2例(6.25%);穿孔3例(9.4%),均行内镜下金属夹闭合,内科治疗成功。术后病理诊断为低级别瘤变19例、高级别瘤变11例、癌变2例。病变局限于黏膜层25例,黏膜下浅层(sm15例,黏膜下深层(sm22例追加外科手术。20例术后随访312个月,平均(7±3.6)个月,均无复发。

    结论  对直径>2 cmLST,选择ESD治疗切除彻底,安全性高,复发率低。

    [关键词] 结直肠肿瘤;侧向发育型肿瘤; 内镜黏膜下剥离术


     

     

    Endoscopic submucosal dissection for colorectal laterally spreading tumors. GONG Wei,LIU Si-de,ZHI Fa-chao,BAI Yang,ZHOU Dan,HUANG Ying,JIANG Bo. Department of Gastroenterology,NanfangHospital, SouthernMedicalUniversity,GuangzhouChina, 510515

    Corresponding author:JIANG Bo,Email:drjiang@163.com

    [Abstract]Objective  To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for the treatment of laterally spreading tumors (LST). Methods  ESD was applied to remove 32 colorectal LSTs larger than2cm. The characteristics of the tumors and clinical results including en bloc resection rate, procedure time, complication and recurrence rates were retrospectively evaluated. Results  The lesions ranged from2.5cmto8.0cm, with a mean diameter of 4.1±2.1cm. En bloc resection was achieved in 29 patients (90.6%) with a mean operation time of 75.7±66min.  Immediate arterial bleeding occurred in 5 (15.6%) cases but was stopped successfully by clips or coagulations. Late bleeding occurred in 2 (6.2%) and perforations in 3 (9.4%), which were closed successfully by clips without surgery. Pathological diagnosis revealed low-grade intraepithelial dysplasia in 19 (59.4%), high-grade intraepithelial dysplasia in 11 (34.4%), and carcinomas in 2 (6.2%). The lesions were restricted in mucosal layer in 25 (78.1%), infiltrating into sm1 layer in 5 (15.6%) and sm2 layer in 2 (6.2%), and the later 2 were referred to surgery. Twenty patients were followed up for 3-12 months, and no local recurrence was found. Conclusion  ESD was an effective and safe therapy for colorectal LST larger than2cm.

    [Key words] Colorectal neoplasms; Laterally spreading tumors; Endoscopic submucosal dissection

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    智发朝 单位:南方医科大学附属南方医院
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    出生:1972-03-17
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