内镜下黏膜切除治疗大肠肿瘤  

Endoscopic mucosal resection for the treatment of colorectal tumors

作　　者：李雨静[1] 齐玲芝[1] 苑坤[1] 刘泳[1] 刘聪[1] 孙巍[1] 

机构地区：[1]吉林省人民医院消化内科,吉林长春130021

出　　处：《吉林医学》2009年第13期1219-1221,共3页Jilin Medical Journal

摘　　要：目的:探讨内镜下黏膜切除术对大肠无蒂大息肉和平坦型病变的治疗价值。方法:采用结肠镜下大肠黏膜切除术治疗72例92个大肠病变。采用病灶黏膜下注射肾上腺素生理盐水后,一次圈套切除(EMR)、分次圈套切除(EPMR)和透明帽辅助黏膜切除法(Cap-EMR)切除病变,回收全部标本送病理检查,术后结肠镜随访。结果:72例患者一次性成功切除病变89个,3例患者各残留1个病变,其中2例再次行EMR,1例行APC氩气凝固灼除。12个月后复查未发现复发病例。术后病理结果:腺瘤71个,其中伴有上皮内瘤变的29个,增生性息肉13个,直肠类癌3个,黏膜内癌变5个,其中2例为SM2癌,行外科手术治疗。12个月后复查未发现复发病例。术中、术后无穿孔病例,术后出血5例。结论:EMR是治疗大肠癌前病变和黏膜内癌简单、安全、有效的方法,可以向基层医院推广。Objective To evaluate the outcome of eodoscopic mucosal resection （EMR） on colorectal large sessile polyps and fiat - type lesions. Method Total 72 patients with 92 lesions received the treatment of EMR. After submucosal injection of epinephrine, the le- sions were treated by EMR,EPMR AND Cap -EMR. All resected specimens were retrieved for pathologic study. Follow-up colonoscopy was performed on all patients after EMR. Results For 89 lesions of 69 patients were removed completely. Each of the rest 3 patients had one lesion left, two of them received EMR again, and the other one received argon plasma coagulation （APC） to burn the lesion. No patients had palindromia in 12 months＇follow-up examination. Histopathologic assessment of the resection specimens revealed：There were 71 adenoid tumor, of which 29 complicated with intraepithelial tumor, 13 hyperplastic polyp, 3 rectum careinoid and 5 intramucosal carcinoma, 2 of which were SM2 carcinoma and received surgery. No patients had palindromia in 12 months＇follow - up examination. No patient had perfora- tion during or after EMR. Five patients had hemorrhage after EMR. Conclusion EMR for large intestinal precancerous and intramucosal carcinoma is a simple, safe and effective treatment and could be pervasively used in inferior hospitals.

关 键 词：结肠镜 黏膜 大肠肿瘤 

分 类 号：R735.34[医药卫生—肿瘤]