内镜反转粘膜切除术REMR治疗低位直肠肿瘤的初步体会.DOCVIP

内镜反转粘膜切除术（REMR）治疗低位直肠肿瘤的Primary experience of retroflex EndoscopicMucosal Resection for low rectal neoplasm Yang Dan,Shen_wenyong,Luo Yong, et al. Department of Gastroenterology,Fuling Center Hospital Of Chongqing City,Fuling,408000,China. Abstract：objective to study the effect on retroflex EndoscopicMucosal Resection(REMR) for super low rectal neoplasm and to discuss the applications and complications.Methods 8 patients were selected as follodw:the tumor size more than 3.0 cm ,the tumor located less than 2.0 cm for anus and the tumor was benign colorectal adenoma with biopsy. REMR were performed and managements and complications were registed?on intranperative and postoperative,then we evaluated the curative effect through the follow-up. Results The 10 tumor lesions were removed in 8 patients by REMR procedures.6 patienact’s tumor were completely cut by once REMR procedure and 2 patienact’s tumor were completely cut by secondary REMR procedure. The curative rate was 100%.All patients were retained anus.Operation time weas from 48 minutes to 137 minutes among 8 patients,average time was 61.4± 15.7 minutes. Conclusions REMR is a new wicresoft techlology and securety and effective for rectal tumor with enteroscope. Patient’s anus is completely retained and quality of life is elevation by REMR. 【Keyword】Retroflex EndoscopicMucosal Resection; rectal neoplasm; low bit 我科2008年以来开展内镜反转粘膜切除术（REMR）治疗低位直肠肿瘤，保肛效果良好，现报道如下： 一．资料与方法,… 1 临床资料 1.1患者情况 2008年12月自2010年7月，我院消化内镜中心经结肠镜检查检出的直肠肿瘤，符合以下条件者纳入研究：直径在3.0cm以上且肿瘤下缘距肛门齿状线2 ★通讯作者：刘爱民iminliu@ 厘米以内，并符合以下内镜治疗指征者纳入研究：病理活检提示为良性腺瘤。符合以上条件，选择REMR进行内镜下治疗。8例患者入选，其中男性2例，女性6例，年龄分布36～83岁，平均年龄58.2岁±5.7岁。 1.2病变分布及大小 8例患者病变分布如下：肿瘤下缘距肛门齿状线1.0cm 者3例，肿瘤下缘距肛门齿状线2厘米者5例；病变大小：直径4.0cm±1.2cm REMR残留病变的术后处理 良性病变REMR时未能完整切除病变，其边缘的少量残留病变术中采用氩气刀（ERBE 350）凝固法对病变行凝固治疗。对术后随访时发现的残留病变，病变直径在5mm以下时用高频电凝固治疗术，病变直径在6mm以上时行再次 EMR或REMR术治疗。 术后随访 所有病例均纳入内镜随访，目前随访时间最多为18个月，最少随访1次，首次随访为术后三个月，以后每12个