预切开内镜黏膜切除术治疗结直肠侧向发育型肿瘤的指征分析(含视频)  

Indication analysis of therapeutic effects of pre-cut-endoscopic mucosal resection on colorectal lateral spreading tumors (with video)

作　　者：金燕[1] 龚镭[1] 王小云[1] 金士毛[1] 唐学军[1] 彭晓斌[1] 朱颖伟 姚礼庆 周平红 李剑 Jin Yan;Gong Lei;Wang Xiaoyun;Jin Shimao;Tang Xuejun;Peng Xiaobin;Zhu Yingwei;Yao Liqing;Zhou Pinghong;Li Jian(Department of Gastroenterology,Wuxi Second People’s Hospital,Wuxi 214000,China;Endoscopy Center,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]无锡市第二人民医院消化科,214000 [2]复旦大学附属中山医院内镜中心,上海200032

出　　处：《中华消化内镜杂志》2020年第10期717-721,共5页Chinese Journal of Digestive Endoscopy

基　　金：无锡市青年医学重点人才基金(QNRC075);上海消化内镜诊疗工程技术研究中心支持项目(19DZ2280100)。

摘　　要：目的探讨预切开内镜黏膜切除术(pre-cut-endoscopic mucosal resection,pre-cut-EMR)治疗结直肠侧向发育型肿瘤(laterally spreading tumors,LSTs)的临床指征。方法回顾性分析2014年1月—2019年6月在无锡市第二人民医院和复旦大学附属中山医院接受pre-cut-EMR治疗的结直肠LSTs患者临床资料,研究分析病灶临床特征与手术成功率及并发症的关系。结果共132例结直肠LSTs病变纳入研究,LSTs内镜分型中颗粒均一型29例(22.0%),结节混合型43例(32.6%),扁平隆起型58例(43.9%),假凹陷型2例(1.5%)。LSTs病灶直径(2.3±1.5)cm(2.0~5.0 cm)。病灶位于直肠36例(27.3%),乙状结肠15例(11.4%),降结肠10例(7.6%),结肠脾曲17例(12.9%),横结肠21例(15.9%),结肠肝曲24例(18.2%),升结肠6例(4.5%),盲肠3例(2.3%)。LSTs病理结果:低级别上皮内瘤变58例(43.9%),高级别上皮内瘤变69例(52.3%),黏膜内癌2例(1.5%),癌变3例(2.3%)。132例LSTs病灶应用pre-cut-EMR治疗,手术时间(25.3±13.6)min(20~65 min),病灶整块切除率95.5%(126/132),完整切除率100.0%(132/132)。术中穿孔2例(1.5%),均位于乙状结肠,病灶直径分别为4.0 cm、4.5 cm。术中即刻出血12例(9.0%),术后迟发出血2例(1.5%)。术后随访6~24个月,术后创面愈合良好,随访期间病灶未见残留及复发。结论内镜下应用pre-cut-EMR治疗直径<4.0 cm的结直肠LSTs病变是安全有效的。Objective To investigate the indication of pre-cut-endoscopic mucosal resection(pre-cut-EMR)on the treatment of colorectal laterally spreading tumors(LSTs).Methods A retrospective study was performed on data of colorectal LSTs patients,who underwent pre-cut-EMR in Wuxi Second People’s Hospital and Zhongshan Hospital from January 2014 to June 2019.The relationships between the clinical characteristics of the lesions and the success rate and complications of pre-cut-EMR were analyzed.Results Data of 132 colorectal LSTs cases were included in the study.Morphology of 29(22.0%)LSTs were homogeneous granular type,43(32.6%)LSTs were mixed non-granular type,58(43.9%)LSTs were flat elevated type,and 2(1.5%)LSTs were pseudo-depressed type.The diameter of lesions was 2.3±1.5 cm(ranged from 2.0 cm to 5.0 cm).Among the 132 LSTs,36(27.3%)tumors were located in rectum,15(11.4%)in sigmoid colon,10(7.6%)in descending colon,17(12.9%)in splenic flexure of colon,21(15.9%)in transverse colon,24(18.2%)in hepatic flexure of colon,6(4.5%)in ascending colon,and 3(2.3%)in cecum.The histopathological diagnoses of the 132 LSTs included low grade intraepithelial neoplasia in 58 cases(43.9%),high grade intraepithelial neoplasia in 69 cases(52.3%),intramucosal carcinoma in 2 cases(1.5%),and canceration in 3 cases(2.3%).Pre-cut-EMR was achieved in all 132 patients,and the operation time was 25.3±13.6 min(ranged 20-65 min).The rate of en bloc resection and complete resection were 95.5%(126/132)and 100.0%(132/132),respectively.Two cases(1.5%)had intraoperative perforation,and were both located in the sigmoid colon with the diameter of 4.0 cm and 4.5 cm,respectively.Twelve cases(9.0%)had immediate bleeding during operation,and 2 cases(1.5%)had delayed bleeding after operation.Patients had been followed up for 6-24 months,the wound healed well after operation,and no local recurrence was found.Conclusion Pre-cut-EMR is an effective and safe therapy for colorectal LSTs with diameter less than 4.0 cm.

关 键 词：结直肠肿瘤 内镜下粘膜切除术 预切开 侧向发育型肿瘤 

分 类 号：R735.34[医药卫生—肿瘤]