改良型水辅助结肠镜下结直肠息肉黏膜切除术的临床应用研究  

Feasibility and safety of modified underwater endoscopic mucosal resection for colorectal polyps

作　　者：施宏[1] 陈建华[1] 陈素玉[1] 黄贺[1] 陈敏敏 黄剑云 邵键伟 Hong Shi;Jian-Hua Chen;Su-Yu Chen;He Huang;Min-Min Chen;Jian-Yun Huang;Jian-Wei Shao(Department of Endoscopy,Fujian Cancer Hospital,Fujian Medical University Cancer Hospital,Fuzhou 350014,Fujian Province,China)

机构地区：[1]福建医科大学附属肿瘤医院福建省肿瘤医院内镜科,福建省福州市350014

出　　处：《世界华人消化杂志》2020年第17期839-846,共8页World Chinese Journal of Digestology

基　　金：福建省卫生计生面向农村和城市社区推广适宜技术项目,No.2016005.

摘　　要：背景内镜黏膜切除术(endoscopic mucosal resection,EMR)广泛用于结直肠息肉切除,但其黏膜下注射可延展病灶,使之难以被圈套器套入.注水内镜黏膜切除术(underwater endoscopic mucosal resection,UEMR)需吸气后以水浸没息肉,有时影响息肉暴露.改良型UEMR将EMR与UEMR优点合二为一,有利于息肉整块切除.目的探讨改良型UEMR提高结直肠息肉整块切除率、减少复发率和并发症的可行性及效果.方法选取2015-07/2019-06在我院内镜科行改良型UEMR治疗的59例结直肠息肉及同期行UEMR治疗43例的结直肠息肉患者为研究对象,改良型UEMR治疗的59例研究组共发现76个病灶,UEMR治疗的43例对照组共发现65个病灶.巴黎分型均为(Is、Ⅱ),息肉大小在1 cm<直径<3 cm.手术方式:退镜观察发现息肉后向肠腔内注入温生理盐水,完全浸泡息肉,将息肉置于6点钟方向,黏膜下注射美兰抬起病灶,采用合适的圈套器予以电切除,创面视病灶大小给予钛夹夹闭,切除的标本结晶紫染色后送病理.结果59例研究组的患者均成功完成改良型UEMR,76例息肉中64例息肉<2 cm,均行整块切除;12例息肉2-3 cm有5例整片切除,7例行注水分片粘膜切除术(underwater endoscopic piecemeal muscosal resection,UEPMR).研究组总整块切除率为91%,<2 cm整块切除率为100%,2-3 cm整块切除率为42%.43例对照组的患者也均成功完成UEMR,65例息肉中58例息肉<2 cm,其中49例患者一次性切除,9例出现息肉残留追加氩等离子体血浆凝固术(argon plasma coagulation,APC)治疗;7例息肉大小2-3 cm,有2例整片切除,1例出现息肉残留追加APC治疗,另外5例行UEPMR或转内镜黏膜下剥离术切除.对照组整块切除率为76%,<2 cm整块切除率为84%,2-3 cm整块切除率为14%.改良型UEMR研究组有9例患者术中出现少量渗血,UEMR对照组中13例患者术中出现出血,采用热活检钳烧灼或钛夹钳夹止血.两组术后均未发生迟发性出血、穿孔等并发症.BACKGROUND Conventional endoscopic mucosal resection(EMR)with submucosal injection has been widely performed to remove colorectal polyps,although it often makes sessile lesions flattened and enlarged,resulting in the failure of lesion snaring.Air deflation and water immersion during underwater EMR(UEMR)sometimes interfere with the exposure of colorectal polyps.Modified UEMR may facilitate the resection of colorectal polyps due to integrating the advantages of EMR and UEMR.AIM To investigate the feasibility and safety of the modified UEMR in the treatment of colorectal polyps.METHODS Fifty-nine patients with 76 colorectal polyps treated by modified UEMR were enrolled in the study from July 2015 to June 2019,and compared with 43 patients with 65 colorectal polyps treated by UEMR during the same period.All lesions were classified as Paris Is or IIa,and the size of the polyp ranged from 1 cm to 3 cm in diameter.Endoscopic procedure was as follows:Once observed,the polyp was completely immersed by warm water infusion.The polyp was placed in the 6 o’clock direction.Following submucosal injection with normal saline plus methylene blue,an appropriate snare was used for en bloc resection.The mucosal defect was closed with clips.The excised specimen was sent for pathological evaluation after crystal violet staining.RESULTS All the 76 lesions in the study group were successfully resected by modified UEMR.Among them,64 polyps less than 2 cm in size received en bloc resection.In 12 polyps ranging 2-3 cm in size,5 received en bloc resection and 7 received piecemeal UEMR.The overall en bloc resection rate was 91%;the rate for those polyps<2 cm was 100%,and the rate for polyps ranging from 2 cm to 3 cm was 42%.All the 65 lesions in the control group were successfully treated by conventional UEMR.Of 58 lesions less than 2 cm in size,49 underwent en bloc resection and the other 9 underwent additional argon plasma coagulation(APC)due to residual lesion.Of 7 lesions ranging from 2 cm to 3 cm in size,2 underwent en bloc resection,1

关 键 词：内镜下黏膜切除术 改良型注水内镜黏膜切除术 结直肠息肉 

分 类 号：R657.1[医药卫生—外科学]