注射法内镜下黏膜剥离切除法治疗结直肠侧向发育型肿瘤的临床效果  

Clinical effect of endoscopic mucosal resection by injection method in the treatment of laterally spreading tumor

作　　者：植中敬[1] 陈慕维 吕建广[2] 邵少慰[3] 沓世念[1] 谭飞鸥 ZHI Zhong-jing CHEN Mu-wei LYU Jian-guang SHAO Shao-wei TA Shi-nian TAN Fei-ou(Department of Gastroenterology,Zhaoqing No.2 People＇s Hospital of Guangdong Provinee,Zhaoqing 526020,China Department of Medical Irnagery,Zhaoqing No.2 People＇s Hospital of Guangdong Provinee,Zhaoqing 526020,China Department of Pathology,Zhaoqing No.2 People＇s Hospital of Guangdong Provinee,Zhaoqing 526020,China)

机构地区：[1]广东省肇庆市第二人民医院消化内科,广东肇庆526020 [2]广东省肇庆市第二人民医院影像科,广东肇庆526020 [3]广东省肇庆市第二人民医院病理科,广东肇庆526020

出　　处：《中国当代医药》2017年第5期43-47,共5页China Modern Medicine

基　　金：广东省肇庆市科技创新指导类项目(肇科[2015]63号)

摘　　要：目的探讨注射法内镜下黏膜剥离切除法(EMR)治疗结直肠侧向发育型肿瘤(LST)的临床效果。方法将2014年7月~2015年12月于我院行EMR治疗的32例LST患者为EMR组,术后对所有标本进行统一规范化处理,并进行全瘤评估。同时选择2010年7月~2014年7月于我院采用传统电凝、氩离子凝固术及外科手术治疗的90例LST患者为传统治疗组。所有患者均于术后3、6、12个月行肠镜随访,评价EMR的治疗效果及安全性。结果所有患者均治疗成功并获得随访。EMR组32例患者均获得完整病理标本,病理提示管状腺瘤18例,绒毛状管状腺瘤9例,绒毛状瘤3例,2例黏液癌。2例黏液癌病例中,1例术后病理标本显示切缘2 mm无病变残留,无须追加外科手术;另1例提示残留,追加外科手术;完整切除率为96.9%。术中未发生穿孔,3例患者出现出血,均镜下止血成功。传统治疗组仅15例患者获得完整标本,均为手术病例,病理结果均提示为腺瘤,其中管状腺瘤10例,绒毛状管状腺瘤3例,绒毛状瘤4例;2例患者发生术中出血,均成功止血,无二次开腹手术病例。EMR组和传统治疗组患者术后3个月的复发率比较(0.00%vs.3.33%),差异无统计学意义(P>0.05),而术后6、12个月的复发率比较(6.25%vs.28.90%,9.40%vs.37.80%),差异有统计学意义(P<0.01)。结论 EMR能处理绝大部分临床内镜下发现的LST,与传统治疗方式比较,具有疗效确切、创伤性小、复发率低、标本完整等优势,值得临床推广。Objective To evaluate the clinical effect of endoscopic mucosal resection（EMR） by injection method in the treatment of colorectal laterally spreading tumor（LST）.Methods 32 patients with LST treated with EMR from July 2014 to December 2015 in our hospital were selected as the EMR group,all the specimens were treated with standardized methods,and the whole tumor was evaluated.90 patients with LST treated by conventional electrocoagulation,argon ion coagulation and surgical operation in our hospital from July 2010 to July 2014 were selected as the conventional treatment group.Patients of the two groups were followed up at 3,6 months and 12 months after operation,and the efficacy and safety of EMR were evaluated.Results All patients were successfully treated and followed up,all 32 patients of the EMR group received complete pathological specimens,and the pathological results showed that 18 cases of tubular adenoma, 9 cases of villous tubular adenoma,3 cases of villi tumor,and 2 cases of mucinous carcinoma.Among the 2 cases of mucinous carcinoma, 1 case of the postoperative pathological specimen showed lesion-free residual tumor at 2 mm margin;additional surgery was not needed;another 1 case showed residual tumor,with additional surgery;the complete resection rate was 96.9%.No intraoperative perforation was observed.Hemorrhage occurred in all 3 patients,and the microscopic hemostasis was successful.Among patients of the conventional treatment group,only 15 cases received complete specimens,which were all surgical cases,showing adenoma.Among them,10 cases were tubular adenoma,3cases were villous tubular adenoma,and 4 cases were villi tumor;bleeding was shown in 2 patients receiving surgery.Intraoperative hemostasis was successful in both patients,and the secondary open surgery was not needed.The recurrence rates at 3 months after the surgery of the EMR group and conventional treatment group（0.00% vs. 3.33%） had no statistically significant difference（P〈0.05）,while recurrence rates at 6,12 months after

关 键 词：注射法 内镜下黏膜剥离切除法 结直肠侧向发育型肿瘤 治疗方式 

分 类 号：R735.34[医药卫生—肿瘤]