摘要
目的评价结直肠腺瘤性息肉和早期癌的内镜治疗效果。方法自2006年1月至2007年10月对245例肠镜发现的腺瘤性息肉，局限于黏膜层、抬举征（＋）的早期癌患者分别进行息肉圈套切除术、内镜黏膜切除术、内镜分片黏膜切除术和内镜黏膜下剥离术。结果253枚病变，大小0．5～8．5cm（平均2．3cm），其中〈2cm 157枚，〉2cm 96枚。内镜下成功切除249枚，内镜切除成功率98．4％（249／253）。内镜治疗中未出现无法控制的创面大出血，2例术后出现迟发出血。1例长蒂息肉治疗后出现少量膈下游离气体，2例直肠病变剥离治疗后出现皮下气肿，保守治疗后气肿减退；4例病变剥离过程中创面见裂口，3例金属夹成功缝合；1例治疗后出现腹胀和腹腔大量游离气体，急诊开腹手术修补创面。总的并发症发生率3．6％（9／253）。内镜治疗后8例接受外科手术（病变局部抬举不良4例，分化不良腺癌1例，高级别瘤变2例，穿孔1例）。术后随访231例，随访期3—22个月（平均14．3个月），内镜黏膜下剥离术后巨大人工溃疡创面3个月基本愈合；3例分片黏膜切除术后复发。结论内镜治疗可以有效切除结直肠腺瘤性息肉和早期癌，提供准确的病理诊断资料，内镜治疗并发症发生率有待进一步降低。
Objective To assess the clinical efficacy of endoscopic treatment for colorectal adenomatous polyps and early-stage carcinomas. Methods Between January 2006 and October 2007, 245 patients with colorectal adenomatous polyps and early-stage carcinomas with lifting sign （ ＋ ） were treated by such endoscopic techniques as polypectomy, endoscopic mucosal resection （EMR）, endoscopic piecemeal mucosal resection （EPMR） and endoscopic submucosal dissection （ESD）. Results Two hundred and fifty-three lesions ranged from 0.5 to 8. 5 cm and the mean resected size was 2.3 cm, of which 157 were smaller than 2 cm and 96 larger than 2 cm. Confirmed pathologically, 249 lesions were successfully resected and the resection rate was 98.4% （249/253）. None of patients had massive hemorrhage during the procedure and 2 had delayed bleeding. 1 had a little free air in abdominal cavity, 2 patients had subcutaneous emphysema due to deep tearing of the muscle layer, all 3 recovered after several days＇ conservative treatment. Visible perforation occurred in 4 cases during the dissection, of which 3 were typically closed with metallic endoclip without surgical treatment, and 1 was managed surgically with obvious distention and much abdominal free air. The rate of resectional complication was judged to be 3.6% （9/253）. Eight cases were transferred to surgery altogether after endoscopic procedure. Two hundred and thirty-one cases were followed up with confirmed healing of the large artificial ulcer after ESD except for local recurrence in 3 cases after EPMR. Conclusions Endoscopic resection appears to be an efficacious procedure to treat adenomatous polyp and early-stage carcinoma and provide pathological information about the whole lesion. Measures should be taken to reduce the complication rate of endoscopic resection in the future.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2008年第18期1386-1389,共4页
Chinese Journal of Surgery
关键词
腺瘤性息肉
结直肠肿瘤
内窥镜检查
胃肠道
早期癌
Adenomatous polyps
Colorectal neoplasms
Endoscopy, gastrointestinal
Earlystage carcinoma
