内镜切割吻合器在经肛门局部切除中低位直肠肿瘤中的应用  

Application of endoscopic cutting stapler in transanal local resection of middle and low rectal tumors

作　　者：彭涛[1] 娄展 李曙光[3] PENG Tao;LOU Zhan;LI Shuguang(Endoscopic Center,the First Affiliated Hospital of Hebei North University,Hebei Zhangjiakou 075000,China;Department of Neurology,the First Affiliated Hospital of Hebei North University,Hebei Zhangjiakou 075000,China;Department of Gastrointestinal Cancer Surgery,the First Affiliated Hospital of Hebei North University,Hebei Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院内镜室,河北张家口075000 [2]河北北方学院附属第一医院神经内科,河北张家口075000 [3]河北北方学院附属第一医院胃肠肿瘤外科,河北张家口075000

出　　处：《现代肿瘤医学》2024年第17期3270-3274,共5页Journal of Modern Oncology

基　　金：河北省2020年度医学科学研究计划(编号:20200536)。

摘　　要：目的:回顾性分析中低位直肠肿瘤经肛门局部切除治疗中采用内镜切割吻合器的应用价值。方法:纳入我院经检查诊断的24例中低位直肠肿瘤患者,使用内镜切割吻合器对直肠肿瘤进行经肛门局部切除,总结分析患者临床病理资料特征及影像学诊断特点,评价该手术方式的安全性及可行性。结果:24例患者便潜血阳性者14例,症状以便血为主,肿瘤位置以前壁为主。随着肿瘤直径的增大,增强CT、MRI、EUS诊断的准确率升高,准确率方面EUS>MRI>增强CT,三者联合评估准确率提高。术后病理结果显示4例为上皮下来源肿瘤(SM层3例,MP层1例)。20例为上皮来源肿瘤,其中上皮来源良性肿瘤9例,为低级别管状腺瘤或低级混合状腺瘤;高级别上皮内瘤变2例;直肠癌9例,其中M层1例,SM层3例,MP层4例,S层1例。24例患者病灶完全切除率为100%,手术完成率为100%,无中转腹腔镜或开腹手术,手术平均时间、手术平均出血量、术后首次排气平均时间、术后住院平均天数分别为(29.25±6.42)min、(15.04±4.12)mL、(35.38±5.94)h、(3.17±0.92)d;术后7例患者出现WBC反应性升高,术后2~4天后均恢复正常,所有患者RBC及HGB计数较术前均降低,但均处于正常值范围,所有患者均无术后并发症。结论:内镜切割吻合器经肛门切除中低位直肠肿瘤具有操作时间短、副损伤小、术后应激反应低、恢复快的优势,该手术方式具有广泛的临床应用前景。Objective:To evaluate the value of endoscopic cutting transnal local resection stapler in the treatment of middle and low rectal tumors.Methods:Twenty-four patients with middle and low rectal tumors were included in this study.They underwent transanal local resection of rectal tumors with endoscopic cutting stapler,to summarize and analyze the clinical and pathological data and imaging diagnosis of the patients,and to observe the safety and feasibility of the operation.Results:14 of the 24 patients were positive for occult blood in stool.The main symptoms were hematochezia.The tumor was mainly located in the anterior wall.With the increase of tumor diameter,the diagnostic accuracy of enhanced CT,MRI and EUS also increased.The accuracy of the combined evaluation of enhanced CT,MRI and EUS was higher than that of the three evaluation results alone.The postoperative pathological results showed that 4 cases were subepithelial tumors,3 cases were located in the submucosa and 1 case was located in the musculi propria.In the 20 of cases epithelial tumors,9 cases were benign tumors of epithelial origin,which were low grade tubular adenomas or low grade mixed adenomas,2 cases of high-grade intraepithelial neoplasia.9 cases of rectal cancer,including 1 case of mucosa invasion,3 cases of submucosa invasion,4 cases of muscle invasion,and 1 case of whole layer invasion.In 24 cases,the complete resection rate was 100%,and the complete operation rate was 100%.No conversion to laparoscopy or laparotomy was performed.The mean time of operation,mean blood loss,mean time of first exhaust and mean days of hospitalization were( 29.25 ± 6.42) min,( 15.04 ± 4.12) m L,( 35.38 ± 5.94)h,( 3.17 ± 0.92) day,respectively.WBC reactivity was increased in 7 patients after operation and recovered to normal at 2 ~ 4 days after operation.RBC and HGB counts were decreased in all patients,but they were in the normal range,all patients had no postoperative complications.Conclusion:Transanal resection of middle and low rectal tumor with endoscopic

关 键 词：直肠肿瘤 内镜切割吻合器 经肛门局部切除术 超声内镜 

分 类 号：R735.37[医药卫生—肿瘤]