内镜黏膜切除术治疗早期大肠癌60例及随访观察

Endoscopic mucosal resection of early colorectal cancer: a report of sixty cases and its follow-up

目的回顾分析内镜下黏膜切除术(EMR)治疗早期大肠癌的安全性、治疗效果,并讨论其随访观察结果。方法对60例早期大肠癌患者以注射法行黏膜切除治疗,记录其操作方法、并发症、术后病理、追加手术情况及随访观察结果。结果 60例早期大肠癌患者经EMR或分片黏膜切除,一次性切除病变43例(71.66%)。根据内镜标本病理及外科手术病理结果,累计完整切除率91.67%(55/60)。并发症:术中出血24例(40%),以钛夹或氩离子凝固术(APC)止血成功。术后1周迟发出血2例(3.33%),内镜下止血成功。无1例穿孔发生。术后病理:黏膜内癌54例,黏膜下癌6例。5例m癌追加外科肠段切除,均无癌残留,但其中1例内镜标本提示癌残留者合并淋巴结转移;2例sm1癌追加外科肠段切除,无淋巴结转移;2例sm2癌追加外科肠段切除,合并淋巴结转移;1例sm3癌追加外科肠段切除,无淋巴结转移。其余m癌及1例拒绝手术的sm1癌,合计50例纳入随访,随访1～50个月,未见病变残留或复发转移。结论内镜黏膜切除术治疗早期大肠癌是安全的,其根治效果取决于操作方法、术后病理标本的判断以及严格术后内镜随访。

【Objective】To analyze the safety, curative effect and prognosis of early colorectal cancer (ECC) treated by endoscopic mucosal resection (EMR) retrospectively. 【Methods】A total of 60 cases of early colorectal cancer initially treated by EMR or endoscopic piecemeal mucosal resection (EPMR) by means of injection were en-rolled. Endoscopic techniques, complications, post-EMR pathological diagnosis, subsequent surgical resection and corresponding pathology were recorded, endoscopic follow-up was included too. 【Result】Of the 60 patients, En bloc resection was performed in 71.66%(43/60) of cases, but the complete resection rate was 91.67% (55/60) based on endoscopic and surgical pathology. The complications were as follows: 24 cases (40%) of hemorrhage during EMR procedure were cured by APC or metal clip. Delayed hemorrhage within the first week after EMR occurred in 2 cas-es (3.33%) and healed by endoscopic means. No perforation occurred. The post-EMR pathological findings showed 54 cases of intramucosal cancer and 6 cases of submucosal cancer. Five patients with intramucosal cancer underwent subsequent surgical resection, no residual cancer found in surgical specimen, but one case with positive endoscopic resection margin had lymph node metastasis. Five cases of submucosal cancer also underwent subsequent surgical resection, 2 of sm1 cases and 1 sm3 case without lymph node metastasis, but 2 of sm2 cases accompined by lymphnode metastasis. The other 49 cases of intramucosal cancer and one case of sm1 cancer who denied surgical inter-vention were enrolled for endoscopic follow-up, no recurrent lesion or metastasis was revealed during the following period of from one to fifty months. 【Conclusion】EMR is a safe endoscopic therapy for the treatment of early col-orectal cancer , its curative effect strictly depends on endoscopic techniques, post-EMR pathological assessment and meticulous endoscopic follow up.