内镜粘膜下剥离术在中低位直肠肿瘤中的应用.docVIP

内镜粘膜下剥离术治疗结直肠扁平癌前期病变和粘膜内癌的临床价值 钟芸诗 姚礼庆 周平红 陈世耀 徐美东 马丽黎 王萍 王红美 【摘要】 目的 评价内镜粘膜下剥离术(endoscopic submucosal dissection, ESD)治疗结直肠扁平癌前期病变和粘膜内癌的临床价值。 方法 2006年11月至2009年2月，复旦大学附属中山医院内镜中心共为35例术前活检病理证实结直肠重度不典型增生和粘膜内癌的患者行ESD术，评价ESD手术的安全性和疗效。结果 35例患者包括重度不典型增生21例，粘膜内癌14例；其中男性21例，占60%，平均年龄62±12（23~87）岁。低位直肠（据肛缘7CM以下）病变14例、中高位直肠7例、乙状结肠4例、肝区病变5例和盲升结肠病变5例。病灶平均直径2.42±2.27（2.0~8.5）CM。所有患者均顺利完成了内镜切除手术，平均手术时间35±45（15~114）min，平均出血量23±15（5~400）ml。其中术中穿孔3例、术中出血7例、术后迟发性出血3例，通过保守治疗好转。35例患者均接受了随访，平均随访时间11±5（3~23）个月，无复发病例。结论 ESD治疗较大的、扁平的结直肠癌前期病变和粘膜内癌具有较好的疗效和安全性，值得推广应用。 【关键词】 结直肠 内镜粘膜下剥离术 癌前期病变 粘膜内癌 The value of endoscopic submucosal dissection treating flat colorectal precancer or cancer in-situ lesions. ZHONG Yun-shi, YAO Li－qing, ZHOU Ping-hong，CHEN Shi-yao，XU Mei-dong，MA Li-li，WANG Ping, WANG Hong-mei. Endoscopic Center, Zhongshan Hospital, Fudan University; Endocopic Research Institute, Fudan University, Shanghai 200032, China Corresponding author：Yao Liqing，email： zhongamy2002@126.com [Abstract] Objective To assess the value of endoscopic submucosal dissection treating flat colorectal precancer or cancer in-situ lesions. Methods 35 patients with flat colorectal precancer or cancer in-situ leisions were treated with ESD 作者单位：200032 复旦大学附属中山医院内镜中心 复旦大学内镜诊疗研究所 通讯作者：姚礼庆 email zhongamy2002@126.com 卫生部临床重点学科项目（2007～2009）——结直肠癌肝转移的早期诊断和综合治疗 2007年上海市科委重大项目“肠癌早期诊疗规范和相关药物临床推广研究”（07DZ19505） from Nov, 2006 to Feb, 2009. Complications and relapse rate were analyzed. Results 21 precancer and 14 cancer in-situ lesions were included, of which there were 21 male patients(60%). Mean age was 62±12（23~87）yrs. In these patients, 14 cases were located in lower rectum(lower than 7CM from anal), 7 in higer rectum, 4 in sigmoid colon, 5 in liver flex and 5 in cecum and ascending colon. All the patients received ESD successfully. The mean operating time was 35±45（15~114）min and mean blood loss was 23±15（5~400）ml. Mean diameter of the lesions was 2.42±2.27（2.0~8.5）CM. The main complications inc