内镜黏膜下剥离术治疗巨大早期低位直肠癌及其癌前病变的价值  

Endoscopic submucosal dissection for early large low rectal carcinomas and its precancerous lesions

作　　者：刘铁梅[1] 周彩芳[1] 时强[2] 陈涛[2] 钟芸诗[2] 任重[2] 蔡贤黎[2] 姚礼庆[2] 

机构地区：[1]复旦大学附属中山医院青浦分院,上海201700 [2]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

出　　处：《中华消化内镜杂志》2013年第3期138-141,共4页Chinese Journal of Digestive Endoscopy

基　　金：2009年上海市科委重大课题（09DZ1950102）;2009年上海市科委生物医药处面上项目（09411967100）;2010年上海市科委生物医药重点项目（10411955900）

摘　　要：目的评价内镜黏膜下剥离术（ESD）在治疗巨大早期低位直肠癌及其癌前病变中的价值。方法对24例病变位于低位直肠且直径超过5cm的早期直肠癌及其癌前病变患者的临床资料进行回顾性总结，分析其临床病理特征、治愈性切除率、并发症及随访结果。结果病灶最长径在5～7cm，平均为5．54cm；操作时间在45—180min，中位时间为85min。整块切除率为91．7％（22／24），治愈性切除率为83．3％（20／24），穿孔发生率为8．3％（2／24），迟发性出血率为12．5％（3／24）。术后随访16—47个月，无局部复发。结论ESD治疗巨大早期低位直肠癌及其癌前病变是安全和可行的，可完整切除病灶，在达到治愈性切除及大块活检的目的同时保留了肛门的功能。Objective To evaluate the therapeutic value of endoscopic submucosal dissection （ESD） for early large low rectal carcinomas and its precancerous lesions. Methods The clinical data, pathology, complications and follow-up results of 24 cases of early large low rectal carcinomas and precancer- ous lesion, which were larger than 5em in diameter and treated by ESD, were retrospectively analyzed. Results The mean diameter of the lesions was 5.54 （5-7）cm, and the mean procedure time was 85 （45- 180）rain. The en bloc resection rate was 91.7% （22/24）, and histologically en bloc resection rate was 83.3% （20/24）. With regard to complication, 3 cases of postoperative hemorrhage （12. 5% ） and 2 cases of perforation （8. 3% ） were recorded, and no local reeurrenee or metastasis was Observed during＇the follow- up of 16-47 months. Conclusion ESD is effective for the treatment of large nonpeduneulated low rectal tumors. The ESD procedure facilitates a more precise pathologic diagnosis and reduees recurrence through en bloc resection, which also retains the function of the anus.

关 键 词：直肠癌 癌前病变 内镜黏膜下剥离术 

分 类 号：R735.3[医药卫生—肿瘤]