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使用或未使用圈套器的内镜黏膜下剥离术对大肠肿瘤的治疗

发布日期:2014-1-29 12:40:23 文章来源:GIE 作者次数:1184
    使用或未使用圈套器的内镜黏膜下剥离术对大肠肿瘤的治疗
     
    背景
    尽管大肠病变的内镜黏膜下剥离术(ESD)有高的整块切除率,但其技术难度和并发症的风险限制了它的广泛使用。
     
    目的
    使用与未使用圈套器行大肠病变的内镜黏膜下剥离术后,分析其结果,ESD-S(未使用圈套器行大肠病变的内镜黏膜下剥离术)是一种简化的内镜黏膜下剥离术改良技术。
     
    设计
    回顾性观察研究。
     
    环境
    一所三级护理转诊中心。
     
    患者和干预
    未使用圈套器的内镜粘膜剥离术用于162例患者中的163处病变。使用圈套器的内镜黏膜下剥离术用于71例患者中的74处病变。所有病变都是大于或等于15毫米的无蒂大肠肿瘤。
     
    主要测量指标
    分析与本手术相关的变量,如整块切除率,手术时间及并发症,并审查病理组织学结果和分析随访数据。
     
    结果
    与使用圈套器的内镜黏膜下剥离术相比,未使用圈套器的内镜黏膜下剥离术中整块切除率较高(87%比64%,P <0.01)。同样组织完整切除率也较高。然而,在未使用圈套器的内镜黏膜下剥离术组和使用圈套器的内镜黏膜下剥离术组中,小于20毫米的病变切除率没有差别, 穿孔和出血发生率也是相似的。而且在两组中发现粘膜下癌分别发生在21%和31%的患者中。每组中有1例病人出现了局部腺瘤复发。
     
    局限性
    回顾设计。
     
    结论
    对于切除大肠肿瘤患者来说,未使用和使用圈套器的内镜粘膜剥离术二者都是安全有效的。内镜粘膜剥离术具有更高整块切除率,表明它是疑似表层黏膜下癌切除术的第一选择。然而 对于小于20毫米大肠病变的整块切除来说,使用圈套器的内镜粘膜剥离术较内镜粘膜剥离术来说是一个不错的选择。
     
    缩写;EMR-P,周围预切后的内镜黏膜切除;ESD,内镜黏膜下剥离;ESD-S,使用圈套器的内镜粘膜切除术
     
     
     
    Endoscopic submucosal dissection with or without snaring for colorectal neoplasms
    Background
    Despite a high en bloc resection rate, its technical difficulty and risk of complications limit the widespread use of colorectal endoscopic submucosal dissection (ESD).
    Objective
    To analyze outcomes after colorectal ESD and ESD with snaring (ESD-S), a simplified modification of ESD.
    Design
    A retrospective observational study.
    Setting
    A single, tertiary-care, referral center.
    Patients and Intervention
    ESD was performed on 163 lesions in 162 patients and ESD-S on 74 lesions in 71 patients. All lesions were nonpedunculated colorectal neoplasms of 15 mm or larger.
    Main Outcome Measurements
    We analyzed procedure-related variables such as en bloc resection rate, procedure time, and complications. Histopathologic results were reviewed. Follow-up data were analyzed.
    Results
    The en bloc resection rate was higher for ESD than for ESD-S (87% vs 64%, P < .01). The histologically complete resection rate was also higher for ESD. However, both rates for resection of lesions of <20 mm were not different between ESD and ESD-S groups. The rates of perforation and bleeding were similar for both groups. Submucosal cancers were present in 21% and 31% of the ESD and ESD-S groups, respectively. One patient from each group developed a local adenoma recurrence.
    Limitations
    Retrospective design.
    Conclusion
    Both ESD and ESD-S were safe and effective for resection of colorectal neoplasms. The higher en bloc resection rate for ESD suggests that it should be the first option for resection of suspected superficial submucosal cancers in the colorectum. ESD-S can be a good alternative to ESD for en bloc resection of colorectal lesions of <20 mm.
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