大肠侧向发育型肿瘤内镜治疗方式的选择  

Different endoscopic therapy in the treatment of colorectal laterally spreading tumor

作　　者：刘振鹏[1] 邓宏炬 梁秀兰[1] LIU Zhen-peng;DENG Hong-ju;LIANG Xiu-lan(Second Gastroenterology Department, Liuzhou Municipal Liutie Central Hospital, Liuzhou, Guangxi 545007, Chin)

机构地区：[1]柳州市柳铁中心医院消化内二科,广西柳州545007

出　　处：《中国临床研究》2018年第6期803-805,共3页Chinese Journal of Clinical Research

摘　　要：目的探讨分片黏膜切除术(EPMR)、优化混合的黏膜剥离术(OHESD)、内镜下黏膜剥离术(ESD)和内镜下黏膜切除术(EMR)在大肠侧向发育型肿瘤(LST)中的应用。方法回顾性分析柳州市柳铁中心医院于2014年1月至2015年12月间收治的34例大肠LST患者手术治疗方式,比较EPMR、OHESD、ESD、EMR四种方式的手术时间、术中出血与穿孔情况。结果 EMR组、EPMR组、OHESD组和ESD组操作时间依次为(36.0±1.7)min、(38.0±6.9)min、(71.0±4.2)min、(120.0±35.0)min,ESD组显著长于另外三组(P<0.05),OHESD显著长于EPMR组和EMR组(P<0.05)。OHESD组、EPMR组和EMR组均未出现明显的术中和术后迟发性出血。ESD组有6例出现较明显的术中出血,1例出现穿孔。结论 ESD操作过程中,若剥离困难,建议不要强行ESD,及时改行EMR切除。Objective To investigate the application of endoscopic piecemeal mucosal resection （ EPMR）, endoscopic submucosal dissection （ESD）, optimized hybrid ESD （OHESD） and endoscopic mucosal resection （EMR） in the treatment of colorectal laterally spreading tumor （LST）. Methods A total of 34 colorectal LST patients who were treated in Liuzhou Municipal Liutie Central Hospital from January 2014 to December 2015 were selected and divided into EPMR group （ n = 2 ） , ESD group （ n = 20 ） , OHESD group （ n = 6） and EMR group （ n = 6） according the operation method. The operation time, intraoperative bleeding and perforation situation were compared between four groups. Results The operation time in EMR group, EPMR group, OHESD group and ESD group were （ 36. 0 ± 1.7 ） min, （ 38.0 ± 6. 9 ） min, （71.0 ± 4. 2） rain, and （ 120. 0 ± 35.0） min respectively. The operation time in ESD group was longer than that in other three groups, and it in OHESD was longer than EPMR group and EMR group （ all P 〈 0. 05）. There were 6 cases of obvious intraoperative bleeding and 1 case of perforation in ESD group, and there were no intra- and post-operative bleeding in OHESD group, EPMR group and EMR group. Conclusion is suggested not to force ESD and should switch to EMR in In the process of ESD operation, if the exfoliation is difficult, it time.

关 键 词：优化内镜黏膜下剥离术 大肠侧向发育型肿瘤 内镜下黏膜切除术 内镜下黏膜剥离术 

分 类 号：R735.34[医药卫生—肿瘤] R615[医药卫生—临床医学]