结直肠黏膜下肿瘤的内镜治疗(附33例分析)  

Endoscopic Treatment of Colorectal Submucosal Tumor:Analysis of 33 Cases

作　　者：李传凤[1] 张蕾[2] 吕愈敏[1] 

机构地区：[1]北京大学第三医院消化科,北京100083 [2]北京市第六医院消化科,北京100007

出　　处：《中国微创外科杂志》2007年第11期1060-1062,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨结肠镜下治疗结直肠黏膜下肿瘤(submucosal tumor,SMT)的指征、方法、疗效及安全性。方法结肠镜及病理学确诊并行结肠镜下治疗的结直肠SMT33例,肿物大小0.2～2.2cm,根部大小0.2～1.2cm。肿物深部注射足量的肾上腺素盐水后,对非举起征阴性者,对准肿物进行吸引并圈套,之后高频电切除。7例较小SMT行钳取。结果结肠镜治疗未出现穿孔、大出血及透壁灼伤并发症。完全切除(内镜治疗后SMT断端及基底未见肿瘤组织或追加外科手术者病理未见肿瘤组织)29例,包括类癌18例,平滑肌瘤6例,错构瘤2例,脂肪瘤2例,神经纤维瘤1例。其中26例随访时间中位数44.5月(3个月～12年7个月),无肿瘤复发,另3例平滑肌瘤失访。残存切除(内镜治疗后SMT断端或基底仍有肿瘤组织残留或追加外科手术者术后病理显示有肿瘤组织)4例,均为类癌。其中2例追加外科手术(1例随访2年3个月无复发,1例失访),另外2例不愿行外科手术,结肠镜随访5个月及2年4个月,均无复发。结论对于根部最大径≤1.2cm,非举起征阴性的SMT可行结肠镜下治疗,结肠镜切除SMT创伤小、安全、疗效好。切除后需行全瘤病理学检查,如为残存切除,应追加外科手术。Objective To discuss the indication, technique, effect, and safety of colonoscopic resection of colorectal submucosal tumor （SMT）. Methods A total of 33 patients with SMT, which was diagnosed colonoscopically and pathologically, were treated by endoscopy. The sizes of the tumors were 0.2 - 2.2 cm in diameter, and 0.2 - 1.2 cm in the diameter of the roots. After injecting adequate adrenalin saline deeply into the root of SMT, the mass of those, who had negative nonlifting sign, was attracted, snared, and then cut using high frequency electrotome. In 7 cases of smaller SMT, the tumor was gripped. Results No perforation, large amount of hemorrhage, or burns of the colorectal wall was found. Complete resection was achieved （ no tumor tissue was detected on the edge or bottom of the SMTs after endoscopic resection, or pathological examination found no tumor tissue after open surgery） in 29 cases, including 18 carcinoids, 6 leiomyomas, 2 hamartomas, 2 lipomas, and 1 neurofibroma. Except 3 patients with leiomyoma were lost, 26 of the patients were followed up for a median of 44.5 months （3 months to 12 years and 7 months）. No recurrence was found during the follow-up. The 4 carcinoids were resected partially （ there were tumor tissues remained on the edge or bottom of the SMTs after endoscopic resection, or the pathological examination after open surgery showed tumors）. Two of the 4 were transferred to open surgery （one was followed up for 2 years and 3 months, the other was lost）. The other two patients refused operation and received a followed-up of 5 months and 2 years and 4 month respectively. None of the 4 patients had recurrence during follow-up. Conclusions Colonoscopic treatment can be applied to the patients with SMT sized ≤ 1.2 cm at the root and negative nonlifting sign. The method is safe, effective, and minimal invasion. Pathological examination is recommended after the colonoscopic resection, open surgery is necessary for the partially resected SMTs.

关 键 词：黏膜下肿瘤 结肠镜治疗 

分 类 号：R735.3[医药卫生—肿瘤]