内镜隧道技术在结直肠大面积侧向发育型肿瘤黏膜下剥离术中的临床应用  

Clinical application of tunnel technique on endoscopic submucosal dissection for colorectal laterally spreading tumor

作　　者：张其德[1] 韩树堂[1] 贺亚敏[2] 姜素峰[1] 葛薇[1] 胡余美[1] 

机构地区：[1]江苏省中医院消化内镜中心,南京210029 [2]江苏省中医院病理科,南京210029

出　　处：《中华消化内镜杂志》2017年第9期630-634,共5页Chinese Journal of Digestive Endoscopy

基　　金：江苏省科技厅临床医学科技专项项目（BL20120701）

摘　　要：目的探讨内镜隧道技术在结直肠大面积侧向发育型肿瘤（LST）内镜黏膜下剥离术（ESD）中的临床作用。方法回顾性分析2015年1月至2016年6月在江苏省中医院消化内镜中心接受引入隧道技术的ESD治疗结直肠大面积（病灶最短径〉4cm）LST的患者资料，分析切除标本大小、手术时间、并发症发生情况、病理性质、整块切除及治愈性切除例数．、结果共收集14例患者，其中男7例、女7例，切除标本最长径4．0～7．0cm，平均（5．18±0．49）cm；手术时间40～120min，平均（63．57±12．95）min。术中2例发生穿孔，无迟发性穿孔、出血发生。术后病理示腺瘤样增生伴隐窝脓肿1例、低级别上皮内瘤变3例、高级别上皮内瘤变6例、原位癌1例、M3期癌1例、SMI期癌2例。整块切除13例，完整切除13例，治愈性切除13例。结论将隧道技术引入ESD治疗结直肠大面积LST安全有效，值得临床推广应用。Objective To investigate the clinic effect of tunnel technique on endoscopic submucosal dissection （ESD） for massive colorectal laterally spreading tumor （LST）. Methods A retrospective study was conducted on the data of patients with colorectal large area LST （the shortest diameter 〉 4 cm ） undergoing ESD by tunnel technique from January 2015 to June 2016 in Digestive Endoscopy Center of Jiangsu Province Hospital of Traditional Chinese Medicine. The size of resected specimens, operation time, complications, pathology results, the number of en bloc resection and curative resection were analyzed. Results A total of 14 cases were collected, including 7 males and 7 females. The longest diameters of resected specimens were from 4. 0 to 7.0 cm with mean size of 5.18± 0.49 cm. The operation times were from 40 to 120 min with mean time of 63.57± 12. 95 min. Intraoperative perforation occurred in 2 cases but no delayed perforation and bleeding occurred. Postoperative pathology showed 1 patient with adenoma hyperplasia with crypt abscess, 3 patients with low grade intraepithelial neoplasia, 6 patients with high grade intraepithelial neophasia, 1 patient with carcinoma in situ, 1 patient with carcinonm in M3, and 2 patients with carcinoma in SM1. The number of cases who received en bloc resection, complete resection, and curative resection were 13, 13, and 13, respectively. Conclusion ESD by tunnel technique is safe and effective in the treatment of colorectal large area LST, which is worth popularizing in clinics.

关 键 词：内镜治疗 内镜黏膜下剥离术 隧道技术 结直肠侧向发育型肿瘤 

分 类 号：R735.3[医药卫生—肿瘤]