内镜下黏膜染色联合黏膜切除术在大肠早癌及癌前病变治疗中的应用

Application of dyeing mucous membrane united with endoscopic mucosal resection to cure the early cancer and precancerosis of large intestine under the enteroscope

目的探讨基层医院对癌变率极高的大肠扁平隆起、平坦、凹陷型及广基浅表性病变进行常规电子大肠镜下黏膜染色联合黏膜下切除术的治疗效果。方法对26例符合条件的患者用0.4%靛胭脂直接喷洒行黏膜染色。于染色肠镜下观察病灶腺窝开口类型。按工藤分类法判断浅表型大肠肿瘤小凹形状。局部黏膜注射1∶10000肾上腺素,或其中加入少量美蓝、甘油果糖,根据黏膜隆起征判断是否行黏膜切除术。观察切除率及并发症。结果26例患者中1次切除(EMR)22例,分次切除(EPMR)4例,其中1例病变创面行夹子缝合。1例并发内镜治疗后便血,行急诊大肠镜检查电烧后止血。2例黏膜层癌病变,内镜治疗后有1例患者本人仍要求外科手术治疗,术后病理组织学检查均未发现癌残留及淋巴结转移;另1例长期内镜随访24个月,未见局部再发及转移。所有患者均无治疗后穿孔、感染。结论使用普通电子染色内镜也可使病灶范围显示清楚,同时观察腺管开口,判断是否行黏膜下切除肿瘤,是一种简单、安全、有效的方法。值得基层医院推广、应用。

[ Objective ] To assess the treatment of dyeing mucous membrane united with endoscopic mucosal resec- tion to hunched, flatted, umbilicate type and superficial pathological changes of large intestine under the common electronics enteroscope in basic hospital. [ Methods ] 0.4% Indicarmine was directly insumated to the mucous mem- brane of twenty six patients, matched with condition. The types of openings of crypt were observed under the dyeing enteroscope. The shape of fovea of superficial tumor was determined by the taxonomy. The 1：10 000 adrenalin, or mixed into a little of glycerin fructose, was injected into mucous membrane in part. According to the sign of hunched mucous membrane, endoscopic mucosal resection was preformed, or not. And then the rate of excision and complica- tion were observed. [Results] Twenty two pathological changes were resected in first time. Four were resected grad- edly. One surface of wound of which was stitched with the clasp, when another had blood in stool and the blood was stanched after examination. Cancer was discovered in the mucous membrane layer of other two patients, one of which demanded surgery personally all the time. By pathological histology of the postoperation, vestigital pathological changes and lymphatic metastasis were not discovered. When pathological changes did not migrate and resend in an- other patient after threety six months. All the patients did not perforate and infect after the treatment. [Conclusion] The range of focus can also be showed clearly by the common electronics enteroscope, and the openings of glandular tube were discovered. And then performing endoscopic mucosal resection, or not, was decided. This was a sort of simple, safe and effective way, which was worth popularization and application in basic hospital.