Endoscopic submucosal dissection for large flat colonic polyp:an analysis of 18 cases

›› 2007, Vol. 27 ›› Issue (08): 1-639.

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Endoscopic submucosal dissection for large flat colonic polyp:an analysis of 18 cases

Department of General Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China

Received:2007-03-10 Revised:2007-04-25 Online:2007-08-14 Published:2007-08-14

内镜黏膜下剥离术治疗大肠巨大平坦息肉18例分析

周平红，姚礼庆，徐美东，钟芸诗，陈巍峰，秦新裕

复旦大学附属中山医院普外科复旦大学上海医学院外科学系，上海200032

通讯作者: 姚礼庆

Abstract

Abstract:

Objective:To assess the clinical efficacy and safety of endoscopic submucosal dissection（ESD）for large flat colonic polyp. Methods:Between August 2006 and March 2007,18 patients with large flat colonic polyp were managed by ESD with the needle knife after chromoscopy,magnification and endoscopic ultrasonography examination as following:(1) injecting sodium chloride fluid into the submucosa to elevate the lesion from the muscle layer;(2) precutting the surrounding mucosa of the lesion;(3) dissecting the connective tissue of the submucosa beneath the lesion. Results:Of 18 large flat colonic polyps,11 located in rectum,3 in sigmoid colon,1 in descending colon,1 in hepatic flexture of colon,1 in ascending colon and 1 in caecum.Polyps ranged from 2.0 to 5.2 cm and a mean resected size was 3.1cm.Confirmed pathologically,all 18 polyps were successfully resected with ESD and en bloc resection rate was 100% (18/18).The mean ESD procedure time was 75 min (ranged from 55 to 115 min).None of patients had massive hemorrhage during ESD which couldn’t be controlled under colonoscope and had delayed bleeding after ESD.One patient had subcutaneous emphysema due to deep tearing of the muscle layer,and recovered after several days’conservative treatment.Perforation occurred in 1 case during the dissection of the lesions,which was typically closed with metallic endoclip without surgical treatment.The perforation rate of ESD was 11.1%(2/18).Twelve cases were followed up after ESD，with confirmed healing of the artificial ulcer with no residue or recurrence. Conclusions:ESD is an efficacious and safe endoscopic surgical procedure to treat large flat colonic polyp,which makes it possible to resect en bloc polyp and provide pathological information about the whole polyp.

Key words: endoscopic submucosal dissection (ESD), endoscopic surgical procedure, colonic polyp

摘要：

目的:探讨内镜黏膜下剥离术（ESD）治疗大肠巨大平坦息肉的应用价值。方法:对2006年8月至2007年3月复旦大学附属中山医院应用肠镜检查发现的18例长径>2cm大肠平坦息肉进行染色、放大内镜观察和微探头超声检查，应用头端弯曲的针形切开刀进行ESD治疗。（1）黏膜下注射生理盐水抬高病变，使病变与肌层相分离；（2）预切开病变周围黏膜；（3）剥离病变下方黏膜下层结缔组织，完整切除病变。结果:18例大肠巨大平坦息肉，直肠11例，乙状结肠3例，降结肠1例，结肠肝曲1例，升结肠1例，盲肠1例。病变长径2.0～5.2cm（平均3.1cm）。所有病例术后全部得到病理证实。所有病变全部一次大块、完整剥离成功，ESD成功率100%。ESD手术时间（自黏膜下注射至完整剥离病变）55～115min，平均75min。ESD术中未出现肠镜下无法控制的大出血，术后无一例出现须再次肠镜下治疗的出血。ESD治疗中1例剥离深至肌层，出现阴囊气肿和颈部皮下气肿，保守治疗后气肿减退。1例剥离病变后见肠壁外脂肪，应用金属夹成功缝合创面。ESD穿孔发生率11.1%（2/18）。术后随访12例，平均随访期4.2个月，无一例病变残留和复发。结论:ESD治疗大肠巨大平坦息肉安全、有效，可以完整切除病变，提供完整的病理学诊断资料。

关键词: 内镜黏膜下剥离术, 内镜外科手术, 大肠息肉

ZHOU Ping-hong,YAO Li-qing,XU Mei-dong,et al.. Endoscopic submucosal dissection for large flat colonic polyp:an analysis of 18 cases[J]. , 2007, 27(08): 1-639.

周平红，姚礼庆，徐美东，钟芸诗，陈巍峰，秦新裕. 内镜黏膜下剥离术治疗大肠巨大平坦息肉18例分析[J]. 中国实用外科杂志, 2007, 27(08): 1-639.

[1]	. [J]. CJPR, 2014, 34(06): 532-536.
[2]	. [J]. , 2012, 32(04): 287-290.
[3]	. [J]. , 2009, 29(05): 440-443.

Endoscopic submucosal dissection for large flat colonic polyp:an analysis of 18 cases

内镜黏膜下剥离术治疗大肠巨大平坦息肉18例分析

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