中国实用外科杂志

中国实用外科杂志 ›› 2011, Vol. 31 ›› Issue (06): 497-500.

• 论著 • 上一篇    下一篇

内镜黏膜下剥离术治疗直肠扁平癌前期疾病和黏膜内癌临床价值

钟芸诗，姚礼庆，许剑民，周平红，吴海福，徐美东   

  1. 复旦大学附属中山医院内镜中心 复旦大学内镜诊疗研究所，上海200032
  • 出版日期:2011-06-01 发布日期:2011-05-24

  • Online:2011-06-01 Published:2011-05-24

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摘要：

目的    评价内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）治疗直肠扁平癌前期疾病和黏膜内癌的临床价值。方法    收集2006年11月至2011年3月复旦大学附属中山医院内镜中心83例行直肠ESD的术前活检资料（术前活检病理均证实重度不典型增生或黏膜内癌），评价ESD手术的安全性和疗效。 结果    83例中低位直肠（距肛缘7cm以下）病变52例，中位直肠（距肛缘7~12cm）18例，高位直肠（距肛缘13~18cm）13例；病灶平均直径（2.29±3.11）cm。所有病人均顺利完成内镜切除手术，手术时间（15~129）min，出血量（5~400）mL。病灶整块切除率85.5%（71/83）。术中穿孔12例（14.5%），术中出血11例（13.3%），术后迟发性出血6例（7.2%），均通过保守治疗好转。83例均接受随访，随访时间3~31（15±6）个月，无复发病例。 结论    ESD治疗较大的、扁平的直肠癌前期疾病和黏膜内癌具有较好的疗效和安全性，值得推广应用。

关键词: 直肠, 内镜黏膜下剥离术, 黏膜内癌

Abstract:

Value of endoscopic submucosal dissection treating flat rectal precancer or cancer in-situ lesions        ZHONG Yun-shi, YAO Li-qing, XU Jian-min, et al. Endoscopic Center, Zhongshan Hospital, Fudan University; Endoscopic Research Institute, Fudan University, Shanghai 200032, China
Corresponding author：YAO Li-qing，E-mail：yao.liqing@zs-hospital.sh.cn
Abstract    Objective    To assess the value of endoscopic submucosal dissection treating flat rectal precancer or cancer in-situ lesions. Methods    Eighty-three patients with flat rectal precancer or cancer in-situ leisions were treated with ESD from November 2006 to March 2011 in the Endoscopic center, Zhongshan Hospital of Fudan University. Complications and relapse rate were analyzed. Results    Fifty-two patients were located in lower rectum (lower than 7cm from anal), 18 in the middle rectum (7-12cm from anal) and 13 in higher rectum (13-18cm from anal). All the patients received ESD successfully. The median operating time was 42（15-129）min and median blood loss was 50（5-400）mL. Mean diameter of the lesions was 2.29±3.11（1.6-8.5）cm. En-bloc resection rate was 85.5%（71/83）. The main complications included perforation in 12 (14.5%) patients, bleeding during the operation in 11 (13.3%) patients and  delayed bleeding in 6(7.2%) patients. All 83 patients were followed up with the mean follow-up time of 3-31（15±6）months and no recurrence occurred. Conclusion    ESD is an effective, safe, minimal invasive method to deal with flat rectal precancer or cancer in-situ leisions.

Key words: rectum, endoscopic submucosal dissection, cancer in-situ