内镜黏膜下剥离术治疗直肠病变  

Endoscopic submucosal dissection for rectal lesions

作　　者：周平红[1] 徐美东[1] 陈巍峰[1] 钟芸诗[1] 张轶群[1] 王萍[1] 王红美[1] 姚礼庆[1] 秦新裕[1] 

机构地区：[1]上海复旦大学附属中山医院普外科、复旦大学上海医学院外科学系,200032

出　　处：《中华消化内镜杂志》2007年第1期4-7,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨内镜黏膜下剥离术治疗直肠病变的应用价值。方法对肠镜发现的较大直肠腺瘤和黏膜下肿瘤应用头端弯曲的针形切开刀进行内镜黏膜下剥离术（ESD）治疗：（1）黏膜下注射生理盐水抬高病变，使病变与肌层相分离；（2）预切开病变周围黏膜；（3）剥离病变下方黏膜下层结缔组织，完整切除病变。结果12例低位直肠病变，大小0．6～4．5cm（平均2．8cm），均成功完成ESD治疗。术后11例病理确诊基底和切缘未见病变累及；1例腺癌累及黏膜下层病例接受外科根治手术，手术标本病理未见肿瘤残留。ESD手术时间（自黏膜下注射至完整剥离病变）30～120min（平均52min）。术中出血量平均约75ml，均经电凝、氩离子凝固术和止血夹成功止血，未出现需再次肠镜下治疗的出血。2例剥离深至肌层，出现皮下气肿和少量膈下游离气体，保守治疗好转。9例1个月后肠镜复查，创面基本愈合。结论ESD是治疗消化道病变的新方法，不仅能切除较大的病变，还能提供完整的病理学诊断资料。以往需要外科手术的消化道早期癌和部分黏膜下肿瘤，通过ESD可以达到同样的治疗效果。Objective To assess the clinical value of endoscopic submucosal dissection（ESD） for rectal lesions. Methods ESD was carried out with the needle knife for large rectal polyps and submucosal tumors as following： （1） injecting fluid into the submucosa to detach the lesion from the muscle layer, （2） pie-cutting the surrounding mucosa of the lesion, and （ 3 ） dissecting the connective tissue of the submucosa beneath the lesion. Results 12 lower rectal lesions ranged from 0. 6 to 4. 5 cm and a mean resected size was 2. 8 cm. Among 12 lesions, 11 were completely resected with lateral and basal resection margins free of tumor tissue. Confirmed by pathology after ESD, one patient was diagnosed as ad with massive invasion into the submucosa, and was treated by additional abdominoperineal resection with lymph node dis- section. The mean ESD procedure time （ from fluid injection to complete dissection） was 52 rain （ ranged firom 30 to 120 min）. Minor bleeding occurred in all of the tumors, and none of patients had massive hemorrhage requiring blood transfusion or emergency colonoscopy due to hematochezia after ESD. 2 patients had subcutaneous emphysema and a little free abdominal air due to deep tearing of the muscle layer, and recovered after several days＇ conservative treatment. 9 patients were followed up with colonoscopy one month after ESD,with confirmed healing of the artificial ulcer. Conclusion ESD is a novel endoscopic surgical procedure that makes it possible to resect whole large lesion and provide pathological information about the whole lesion. Many lesions, such as early GI cancer and submucosal tumor, can now be cured by ESD to achieve the same therapeutic result as surgery.

关 键 词：直肠 内窥镜外科手术 内镜黏膜下剥离 消化道病变 

分 类 号：R735[医药卫生—肿瘤]