内镜隧道剥离术在结直肠病变中的临床应用  

Submucosal tunneling endoscopic resection for colorectal lesions

作　　者：周巍[1] 于红刚[1] Wei Zhou;Hong-gang Yu(Department of Gastroenterology,People’s Hospital of Wuhan University,Wuhan,Hubei 430060,China)

机构地区：[1]武汉大学人民医院消化内科,湖北武汉430060

出　　处：《中国内镜杂志》2018年第9期28-33,共6页China Journal of Endoscopy

摘　　要：目的观察内镜隧道剥离术在结直肠病变中的应用价值。方法回顾性分析2017年4月-2017年6月武汉大学人民医院收治的17例结直肠病变患者临床资料,17例患者中8例患者经内镜隧道剥离术治疗(隧道组),9例行内镜黏膜下剥离术(ESD)治疗(ESD组)。初步评估内镜隧道剥离术治疗结直肠病变的有效性及安全性。结果两组在性别比例、病灶部位、病灶大小以及术后病理结果上差异均无统计学意义(P>0.05)。所有病变均一次性完整切除;隧道组平均手术时间(45.0±15.0)min,ESD组平均手术时间(67.0±17.0)min;隧道组术中出血发生率12.5%(1/8),ESD组66.7%(6/9),组间差异明显(P<0.05)。隧道组术中穿孔发生率0.0%,ESD组22.2%(2/9);ESD组有1例出现术后迟发性出血;两组均未出现术后迟发性穿孔;隧道组术后感染发生率12.5%(1/8),ESD组11.1%(1/9),以上组间差异均无统计学意义(P>0.05)。随访中无病例失访,术后1个月结肠镜复查两组均未发现病灶残留或复发。结论内镜隧道剥离术和ESD均可以用于结直肠病变的治疗,相比传统ESD技术,内镜隧道剥离术在手术时间、术中出血率上更有优势,有望成为治疗结直肠病变的主要方法。Objective To investigate the application value of submucosal tunneling endoscopic resection in the treatment of colorectal lesions.Methods The clinical data of 17 patients who were found to have colorectal mucosal lesions by colonoscopy and underwent endoscopic submucosal dissection(ESD)and submucosal tunneling endoscopic resection treatment from April 2017 to June 2017 were retrospectively analyzed.There were 8 cases in study group with submucosal tunneling endoscopic resection treatment,9 cases were treated with ESD in control group.Results There were no statistical differences between the two groups in gender,lesion location,lesion size and postoperative pathological diagnosis(P>0.05).All lesions in the two groups were all curative and enbloc resection.The mean operating time was significantly shorter in study group(45.0±15.0)min than that in control group(67.0±17.0)min;The rates of bleeding during operating were 12.5%and 66.7%respectively.There were statistical difference between the two groups in the above data(P<0.05).The rates of perforation was 0.0%and 22.2%;Delay bleeding rates of the groups were 0.0%and 11.%;postoperative infection were 12.5%and 11.1%respectively;There were no statistical difference between the two groups in any of these data(P>0.05).No residual lesion or recurrent lesion was found in the follow-up one month after operating.Conclusion Submucosal tunneling endoscopic resection and ESD can be used in the treatment of colorectal lesions.Compared with ESD,submucosal tunneling endoscopic resection has more advantages in the operating time and blood loss.Submucosal tunneling endoscopic resection is a safe and effective treatment for patients with colorectal lesions.It is expected to become the main method of treatment of colorectal lesions.

关 键 词：结直肠 内镜隧道剥离术 内镜黏膜下剥离术 手术时间 术中出血率 

分 类 号：R574.62[医药卫生—消化系统] R574.63[医药卫生—内科学]