内镜治疗早期肠道肿瘤相关问题探讨  

Application of different endoscopic excisions in colorectal tumor treatment

作　　者：钟芸诗[1] 

机构地区：[1]复旦大学附属中山医院内镜中心

出　　处：《中华结直肠疾病电子杂志》2014年第1期12-15,共4页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：国家自然科学基金项目(81101566);上海市科委重大课题基金(11411950500);上海市卫生局人才基金(XYQ2011017)

摘　　要：内镜黏膜下剥离术(ESD)与内镜黏膜切除术(EMR)是消化道内镜手术中的两种重要手术方式,目前基于两者又出现了改良的新术式:ESD-S(ESD with snare,ESD联合圈套器法)与EMRP术(EMR with precutting,预环切EMR法)。这四种手术方式在治疗结直肠肿瘤中具有各自不同的优缺点,如较高的完全切除率,较低的并发症风险等。综合近几年国际发表的临床试验,笔者认为:对于直径小于20 mm的结直肠肿瘤,可根据肿瘤的情况,选择ESD术、ESD-S术,EMR-P术或者EMR术。对于直径大于20 mm的肿瘤,ESD术与ESD-S术由于其较低的复发率与较高的完全切除率,可以作为处理此类肿瘤的首选。如上述两种术式风险较高,可以采用EMR-P进行处理。EMR术由于完全切除率较低,复发率偏高,而大于20 mm肿瘤恶变风险较高,不适合用于这类肿瘤的切除。Endoscopic submucosal dissection ( ESD ) and endoscopic mucosal resection ( EMR ) are useful therapeutic techniques for colorectal tumors .Nowadays new techniques based on them had been developed ,such as endoscopic submucosal dissection with snare ( ESD-S ) and endoscopic mucosal resection with precutting(EMR-P).Each of them has its characteristic in excision of colorectal tumor such as high complete resection rate ,low recurrence rate or low complications rate .We referred to the clinic trails which had been published recent years to search for the most appropriate endoscopic treatment for different kinds of tumor.And we found that for the tumor which diameter is less than 20mm,depending on the condition of tumor,surgeon can choose ESD ,ESD-S,EMR-P or EMR.On the other hand,for the large tumor,which is more than 20mm in diameter,ESD and ESD-S would be the first choice.However,if the tumor has high risk in complications occurring by ESD or ESD-S,using EMR-P will be suitable.Because the high possibility of canceration in tumor which is larger than 20mm in diameter,EMR is not an appropriate endoscopic treatment in the excision of colorectal tumor ,due to the low complete resection rate and high recurrence rate .

关 键 词：结直肠肿瘤 内镜下切除术 内镜黏膜下剥离术 内镜黏膜切除术 

分 类 号：R735.3[医药卫生—肿瘤]