内镜下全层切除术治疗结直肠黏膜下肿瘤的价值

Feasibility of endoscopic full-thickness resection in the treatment of colorectal submucosal tumors

目的探讨内镜下全层切除术（EFTR）治疗结直肠黏膜下肿瘤（SMT）的可行性和安全性。方法回顾性分析2009年9月至2012年3月间复旦大学附属中山医院内镜中心实施EPTR切除的4例结直肠SMT患者的临床资料。结果4例患者中男性1例，女性3例，年龄33。78岁；肿瘤位于上段直肠2例，升结肠1例．降结肠1例。4例EFTR手术均获成功并完整切除肿瘤．手术时间24-80（平均48．0）min，切除肿瘤最大径为0.8．2．0（平均1．45）cm。术后病理结果提示分别为神经鞘瘤、囊样积气症、子宫内膜异位症和黏膜肌层平滑肌轻度增生。术中及术后均未出现出血和穿孔，有2例患者术后出现腹痛、发热，其中1例出现局限性腹膜炎体征，均经禁食、静脉抗炎补液等保守治疗后好转，未行外科干预。术后随访1-30个月，未发现肿瘤残留或复发。结论EPTR治疗结直肠SMT安全、有效。

Objective To investigate the feasibility and safety of endoscopic full-thickness resection （EFTR） in the treatment of colorectal submucosal tumor （SMT）. Methods From September 2009 to March 2012, 4 cases with colorectal SMT received EFTR at the Endoscopic Center in the Zhongshan Hospital of Fudan University. The operative time, complications, and follow-up data were analyzed. Results There were 3 females and 1 male. The age ranged from 33 to 78 years. The tumor location included the upper rectum （n=2）, the ascending colon （n= 1 ）, and the descending colon （n= 1 ）. The mean operative time was 48.0 （24-80） min. The mean diameter was 1.45 （0.8-2.0） cm. Postoperative pathological examination revealed schwannoma, pneumatosiscystoidesintestinalis, endometriosis, and mild hyperplasia of smooth muscle in the muscularis mucosa. There was no bleeding or perforation intraoperatively and postoperatively. Two patients developed abdominal pain and fever, one of whom had regional peritonitis and was managed by fasting and intravenous antibiotics. No surgical intervention was required. Postoperative follow up ranged from 1 to 30 months and no residual cancer or recurrence was found. Conclusion EFTR is a safe and effective method for colorecal SMT.