内镜下分片冷切除术治疗最大径≥20 mm结直肠侧向发育型肿瘤的安全性和有效性  

Safety and efficacy of piecemeal cold snare polypectomy for≥20 mm colorectal laterally spreading tumor

作　　者：徐威[1] 诸炎 付佩尧 徐佳昕 周静洁[1] 钟晓锋[1] 沈明 汤瑜[1] 花海兵[1] 胡学军[1] 姚平[1] 陈巍峰 胡健卫 周平红 李全林 XU Wei;ZHU Yan;FU Pei-yao;XU Jia-xin;ZHOU Jing-jie;ZHONG Xiao-feng;SHEN Ming;TANG Yu;HUA Haibing;HU Xue-jun;YAO Ping;CHEN Wei-feng;HU Jian-wei;ZHOU Ping-hong;LI Quan-lin(Department of Gastroenterology,Jiangyin Hospital of Chinese Medicine,Jiangyin 2014400,Jiangsu,China;Endoscopy Center and Endoscopy Research Institute,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Shanghai Collaborative Innovation Center of Endoscopy,Shanghai 200032,China)

机构地区：[1]江苏省江阴市中医院消化内科,江阴214400 [2]复旦大学附属中山医院内镜中心,上海200032 [3]上海市内镜微创协同创新中心,上海200032

出　　处：《中国临床医学》2023年第3期474-479,共6页Chinese Journal of Clinical Medicine

基　　金：2021年上海市“医苑新星杰出青年人才”和上海市卫健委临床研究卓越项目(20224Z0005);江阴市科技局项目(JY0603A021014210026PB)。

摘　　要：目的评价内镜下分片冷切除术治疗最大径≥20 mm结直肠侧向发育型肿瘤(LST)的安全性和有效性。方法前瞻性纳入2021年11月至2022年6月接受诊治的最大径≥20 mm的结直肠LST患者。病变黏膜下注射染色剂后,采用圈套器进行内镜下分片冷切除。主要研究终点指标为内镜切除术后6个月病变复发率;次要研究终点指标为不良事件(如出血、穿孔)发生率等。结果共13例患者纳入研究,病灶平均最大径为2.3(2~3.3)cm。13例肿瘤均成功完成内镜下分片冷切除,平均分片4.2(2~7)片,手术平均时间为16.1(7~31)min。术中出血1例,经金属夹夹闭成功止血;未出现深层损伤、迟发性出血和迟发性穿孔。所有患者均于术后第6个月接受监测性结肠镜检查,均未发现局部复发及远处转移。结论内镜下分片冷切除术治疗最大径≥20 mm结直肠LST安全、有效。Objective To investigate the safety and efficacy of piecemeal cold snare polypectomy(p-CSP)for≥20 mm large colorectal laterally spreading tumor(LST).Methods Eligible patients with colorectal LST with large diameter≥20 mm were prospectively included between November 2021 and June 2022.After submucosal injection of staining agent in the lesion,the snare was used to perform endoscopic p-CSP.The primary outcome was the lesion recurrence within 6 months after p-CSP.The secondary outcome was adverse events(such as bleeding,perforation)happening,etc..Results A total of 13 patients were included,and the average diameter of the lesions was 2.3(2-3.3)cm.All tumors were successfully removed by p-CSP with 16.1(7-31)minutes of average operation time,and the average number of slices was 4.2(2-7).One case of intraoperative bleeding was successfully managed by metal clips.There was no intraoperative deep injury,delayed bleeding or delayed perforation.All patients received surveillance colonoscopy inspection 6 months after operation,and there was no local recurrence or distant metastasis.Conclusion p-CSP might be safe and effective for colorectal LST≥20 mm.

关 键 词：内镜下分片冷切除术 结直肠侧向发育型病变 复发 

分 类 号：R735.3[医药卫生—肿瘤]