内镜肌层间剥离术在早期直肠癌诊断性切除中的一例应用报告  

Report on the application of endoscopic intermuscular dissection for diagnostic resection of early rectal cancer

作　　者：范德军[1] 黄凌玉 齐静雯 伍秋宁 孔宪和 李初俊[1] Fan Dejun;Huang Lingyu;Qi Jingwen;Wu Qiuning;Kong Xianhe;Li Chujun(Department of Digestive Endoscopy,the Sixth Affiliated Hospital of Sun Yat-sen University,Guangzhou 510655,China;Department of Pathology,the Sixth Affiliated Hospital of Sun Yat-sen University,Guangzhou 510655,China)

机构地区：[1]中山大学附属第六医院消化内镜科,广州510655 [2]中山大学附属第六医院病理科,广州510655

出　　处：《中华胃肠外科杂志》2024年第6期630-633,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的介绍内镜肌层间剥离术(EID)这一新技术应用于早期直肠癌诊断性切除的经验,并分享其术后垂直切缘情况。方法2024年1月26日,对1例70岁男性早期直肠癌(cTNM:T1~2N0M0)患者开展了内镜肌层间剥离术。肿物位于直肠左前壁距肛缘9 cm,直径20 mm。内镜肌层间剥离术包括以下6个步骤:(1)黏膜切开;(2)黏膜下剥离;(3)浅肌层切开;(4)肌层间剥离;(5)肿物完整切除;(6)创面处理。剥离速度为2.68 mm2/min,手术全程为109 min。结果术后第5天顺利出院,内镜术后病理为pT1b,垂直切缘阴性。术后随访1月余,恢复良好,无出血、穿孔、感染或狭窄等并发症发生;肠镜结果提示见增生物,活检病理提示炎性肉芽组织形成。结论EID应用于早期直肠癌诊断性切除的安全性尚可,且可获得垂直切缘阴性结果。Objective This report presents the initial outcomes of endoscopic intermuscular dissection(EID),a novel technique introduced by our team for the diagnostic resection of early rectal cancer,focusing on the postoperative status of the vertical margins.Methods On January 26,2024,a patient with early rectal cancer(cT1-2N0M0)underwent Endoscopic Intermuscular Dissection.The EID procedure consists of six steps:(1)mucosal incision;(2)submucosal dissection;(3)superficial muscular layer incision;(4)intermuscular dissection;(5)complete tumor removal;(6)wound management.Results The patient was a 70-year-old male with rectal cancer(cT1-2N0M0).The tumor was located on the left anterior wall of the rectum,approximately 9 cm from the anal margin,and measured 20mm in size.The dissection rate was 2.68 mm²/minute,and the total duration of the surgery was 109 minutes.The patient was successfully discharged on the fifth day after surgery.Pathological examination of the post-endoscopic surgery specimen revealed pT1b,with negative vertical margins.Follow-up after more than one month showed good recovery with no complications such as bleeding,perforation,infection,or stricture occurring.Colonoscopy indicated the presence of a granulation tissue suggestive of inflammation.Conclusion Endoscopic Intermuscular Dissection for the diagnostic resection of early rectal cancer is potentially safe and may achieve negative vertical margins.

关 键 词：直肠肿瘤 早期 内镜肌层间剥离术 诊断性切除 

分 类 号：R735.37[医药卫生—肿瘤]