橡皮圈腔内牵引辅助内镜黏膜下剥离术在结直肠侧向发育型病变治疗中的应用  

Application of rubber ring endoluminal traction assisted by endoscopic mucosal dissection in the treatment of colorectal lateral developmental type lesions

作　　者：刘林霞[1] 马洁云[1] 佟广海 陆博文 田晓锋[1] LIU Linxia;MA Jieyun;TONG Guanghai;LU Bowen;TIAN Xiaofeng(Department of Endoscopy Center,Nantong Tumor Hospital of Jiangsu Province,Nantong,Jiangsu,226361)

机构地区：[1]江苏省南通市肿瘤医院内镜中心,江苏南通226361

出　　处：《实用临床医药杂志》2022年第23期31-34,共4页Journal of Clinical Medicine in Practice

摘　　要：目的分析橡皮圈腔内牵引辅助内镜黏膜下剥离术(ESD)治疗结直肠侧向发育型病变的操作方法、安全性和疗效。方法选取南通市肿瘤医院内镜中心2016年1月—2022年6月收治的85例行ESD治疗的结直肠侧向发育型病变患者作为研究对象,均采用橡皮圈腔内牵引辅助ESD技术(标记病变、黏膜下注射、环形切开、橡皮圈固定病变和完整剥离病灶)治疗。观察本组患者病变完整切除率、手术操作时间、术中并发症、术后并发症和术后复发情况。结果85例患者病变完整切除率为100.0%,手术时间30~110 min,中位时间55 min;5例患者术中发生少量出血(平均出血量20 mL),均经内镜下电凝成功止血;1例患者出现术后迟发性穿孔,经保守治疗后好转。2例患者术后病理结果提示腺癌,黏膜下层浸润深度大于1000μm,四周切缘阴性,后追加外科手术治疗。随访3~6个月,所有患者创面预后良好,无局部复发。结论橡皮圈腔内牵引辅助ESD技术能为术者提供良好的操作视野,可缩短手术操作时间,降低结直肠侧向发育型病变患者术中及术后并发症发生率。Objective To analyze the operating methods,safety and efficacy of rubber band endoluminal traction assisted by endoscopic mucosal dissection(ESD)in the treatment of colorectal lateral developmental type lesions.Methods Eighty-five patients with colorectal lateral developmental lesions undergoing ESD treatment admitted to Endoscopy Center of Nantong Cancer Hospital from January 2016 to June 2022 were selected as study objects,and all patients were treated with the elastic band endoluminal traction assisted by ESD technology(marking the lesion,submucosal injection,annular incision,fixation of the lesion by elastic band,complete dissection of the lesion).The complete resection rate,operation time of operation,intraoperative complications,postoperative complications and postoperative recurrence were observed.Results The complete resection rate of 85 patients was 100.0%,the operative time was 30 to 110 min,with the median time of 55 min.There was 5 cases had a small amount of bleeding(with mean volume of 20 mL)during the operation,which was stopped by electric coagulation.Postoperative delayed perforation occurred in 1 patient and was improved after conservative treatment.Postoperative pathology of two patient suggested adenocarcinoma with submucosal infiltration greater than 1000μm.The peripheral margin was negative,and then additional treatment was given.One patient had postoperative perforation,and was improved after conservative treatment.During follow-up for 3 to 6 months,all patients had good wound healing without local recurrence.Conclusion Rubber band endoluminal traction assisted by ESD can provide the operator with a good view of the operation,shorten the operation time and reduce incidence rates of complications in intraoperation and postoperation.

关 键 词：结直肠侧向发育型病变 内镜黏膜下剥离术 橡皮圈 腺癌 迟发性穿孔 

分 类 号：R574[医药卫生—消化系统] R735.3[医药卫生—内科学]