内镜黏膜下剥离术治疗结直肠扁平癌前期病变和黏膜内癌的临床价值  

Endoscopic submucosal dissection for flat colorectal precancer or cancer in-situ lesions

作　　者：钟芸诗[1] 姚礼庆[1] 周平红[1] 陈世耀[1] 徐美东[1] 马丽黎[1] 王萍[1] 王红美[1] 

机构地区：[1]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,上海200032

出　　处：《第三军医大学学报》2009年第16期1539-1541,共3页Journal of Third Military Medical University

基　　金：卫生部临床重点学科项目(2007-2009);2007年上海市科委重大项目(07DZ19505)~~

摘　　要：目的评价内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗结直肠扁平癌前期病变和黏膜内癌的临床价值。方法收集2006年11月至2009年2月,于复旦大学附属中山医院内镜中心行ESD术的35例术前活检病理证实结直肠重度不典型增生和黏膜内癌患者资料,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,黏膜内癌14例;其中男性21例,女性14例,年龄23～87(62±12)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。病灶直径2.0～8.5(2.4±2.3)cm。患者均顺利完成了内镜切除手术,手术时间15～114(中位数38)min,出血量5～400(中位数32)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,随访时间3～23(11±5)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黏膜内癌具有较好的疗效和安全性,值得推广应用。Objective To assess the value of endoscopic submucosal dissection （ESD） for flat colorectal precancer or cancer in-situ lesions. Methods ESD was performed in 35 patients [ male ： 21,60% ; age ： 23 - 87 （62 ± 12） years old] with flat colorectal precancer or cancer in-situ lesions from Nov, 2006 to Feb, 2009. Complications and relapse rate were analyzed. Results There were 21 cases of preeancer and 14 cases of cancer in-situ lesions. In these patients, lower rectal lesions （lower than 7 cm from anal） were found in 14 cases, upper rectal lesions in 7 cases, lesions of the sigmoid colon in 4 cases, lesions of the liver flex in 5 cases, and lesions of the cecum and ascending colon in 5 cases, respectively. All the patients underwent ESD successfully. The median operative time was 38 （15 -114） rain and median blood loss was 32 （5 -400） ml. Mean diameter of the lesions was [ 2.0 - 8.5 （2.4 ± 2.3） ] cm. The main complications included perforation in 3 cases, intraoperative bleeding in 7 cases, and delayed bleeding in 3 cases. A follow-up for 3 - 23 （ 11 ± 5 ） months found no recurrence in all cases. Conclusion ESD is an effective, safe, minimal invasive method for the treatment of flat colorectal precancer or cancer in-situ lesions.

关 键 词：结直肠 内镜黏膜下剥离术 癌前期病变 黏膜内癌 

分 类 号：R574[医药卫生—消化系统] R730.56[医药卫生—内科学]