内镜和腹腔镜联合应用在治疗较大大肠侧向发育型肿瘤中的临床价值

Endoscopic and laparoscopic cooperative surgery for large colorectal laterally spreading tumors

目的:探讨内镜和腹腔镜联合应用在治疗较大大肠侧向发育型肿瘤(laterally spreading tumor,LST)中的临床价值.方法:回顾性总结21例确诊为LST且直径>3cm患者内镜和腹腔镜双镜联合治疗效果.结果:21例双镜联合治疗患者,根据术前电子肠镜活检病理结果、靛胭脂染色及超声内镜诊断,分别行腹腔镜辅助内镜切除术9例、内镜辅助腹腔镜手术7例,其中1例追加腹腔镜根治术以及内镜和腹腔镜同时治疗5例.术中切除标本送检快速冰冻切片病理检查证实:低级别上皮瘤变者13例(61.9%),高级别上皮瘤变者7例(33.3%),癌变者1例(4.8%),病变以结节混合型为主9例(42.9%),其次为扁平隆起型8例(38.1%).术后平均随访18 mo,无1例转移、复发.结论:对直径>3 cm的LST,采用内镜和腹腔镜双镜联合治疗,对病灶定位准确,创伤小,治疗安全、彻底、复发率低.

AIM： To investigate the value of endoscopic and laparoscopic cooperative surgery in the treatment of colorectal laterally spreading tumors（LSTs）.METHODS： A retrospective analysis of 21 patients with colorectal LSTs lager than 3 cm treated by endoscopic and laparoscopic cooperative surgery was performed. RESULTS： According to endoscopic biopsy, indigo carmine staining and endoscopic ultrasonography, laparoscopic assisted endoscopic resection was performed in 9 cases, endoscopic assisted laparoscopic operation in 7 cases, including 1 case that underwent additional laparoscopic radical operation, and simulta-neous endoscopic and laparoscopic treatment in 5 cases. Intraoperative frozen section pathological examination revealed that there were 13（61.9%） cases of low-grade intraepithelial dysplasia, 7（33.3%） cases of high-grade intraepithelial dysplasia, and 1（4.8%） case of carcinoma. Main lesions were mixed type nodules（42.9%） and flat elevated type（38.1%）. The average follow-up time was 18 mo, and no metastasis or recurrence was found during follow-up. CONCLUSION： Endoscopic and laparoscopic cooperative surgery offers a minimally invasive, effective and safe therapeutic approach for LSTs lager than 3 cm.