内镜黏膜下剥离术治疗结肠巨大侧向发育型肿瘤的疗效分析  

Efficacy of endoscopic submucosal dissection on colon large laterally spreading tumor

作　　者：于劲[1] 樊超强[1] 邓磊[1] 谢霞[1] 杨歆[1] 廖忠莉[1] 聂绪彪 谯秋健 杨仕明[1] 柏健鹰[1] 

机构地区：[1]第三军医大学新桥医院消化内科,重庆400037

出　　处：《第三军医大学学报》2014年第24期2492-2495,共4页Journal of Third Military Medical University

摘　　要：目的探讨内镜黏膜下剥离术（endoscopic submucosal dissection,ESD）治疗结肠巨大侧向发育型肿瘤（lateraly spreading tumor,LST）的可行性及安全性。方法对于28例直径大于5 cm的LST行ESD治疗,对其临床资料进行回顾性研究,归纳分析其治愈性情况、病理特征及并发症发生情况。结果 28例病变均为颗粒型（LST-G）,其中颗粒均Ⅰ型7例,结节混合型21例,病变直径约（6.88±2.10）cm,最大病变直径约12 cm,其中环周病变为4例,手术操作时间为25-380 min,中位时间为72.5 min,病变整块切除率为92.2%（26/28）;治愈性切除率为89.3%（25/28）;穿孔发生率为10.7%（3/28）;迟发性出血发生率为10.7%（3/28）,术后狭窄发生率为10.7%（3/28）,术后随访3-29个月未见局部复发。结论未侵犯黏膜下层的LST行内镜黏膜下剥离术是可行的,但其手术难度较大,因此必须要经验丰富的内镜医师在完善的内镜设备情况下进行具有较高的安全性及较好的疗效,值得临床推广应用。Objective To evaluate the efficacy and safety of endoscopic submucosal dissection（ESD）for the treatment of colon large laterally spreading tumor（LST）.Methods ESD was applied to treat 28 cases of colon LST with diameter larger than 5 cm（large LST）.The therapeutic effect,pathologic characteristics and complications were retrospectively evaluated.Results The 28 cases of colon large LSTs were granular type（LST-G）,including 7 cases of homogeneous granular type,and 21 cases of nodular mixed tumor.The tumor diameter was about 6.88 ± 2.10 cm,and the largest was 12 cm.The operation time was in the range of 25 to380 min,and the medium time was 72.5 min.The complete resection rate was 92.2%（26 /28）,and the curative resection rate was 89.3%（25 /28）.The perforation rate,delayed bleeding rate and postoperative stenosis rate were 10.7%（3 /28）,10.7%（3 /28） and 10.7%（3 /28）,respectively.There was no recurrence after postoperative follow-up for 3 to 29 months.Conclusion ESD is effective and safe for the treatment of colon large LST without invading the submucosa.The surgery has high risk,so it is recommended to be done by experienced doctors with proper equipment.

关 键 词：结肠侧向发育型肿瘤 内镜黏膜下剥离术 

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