内镜下黏膜剥离术治疗结直肠黏膜内癌及癌前病变的有效性及安全性分析

Endoscopic subcucosal dissection in treatment of colorectal carcinoma in situ and precancerous lesions

目的探讨内镜黏膜下剥离术(ESD)治疗结直肠黏膜内癌及癌前病变的有效性及安全性。方法回顾性分析该院2016年6月-2018年2月收治的25例结直肠黏膜内癌及癌前病变行ESD治疗的患者资料,评价ESD手术的安全性和疗效。结果 25例结直肠黏膜内癌及癌前病变,病灶大小1.1～6.9 cm,平均3.2 cm,手术时间35～240 min,平均85 min,一次性完整切除病灶21例,完整切除率为84.0%(21/25),3例病变部分剥离后高频电圈套器分次切除,1次术中出血转外科手术。所有病例术中均未发生穿孔,2例发生术后迟发性出血,再次内镜止血成功。所有ESD患者术后3个月复查,创面愈合率达100.0%,平均随访半年,局部无残留或复发。结论 ESD治疗结直肠黏膜内癌及癌前病变有较好的疗效和安全性,能实现较大病变的完整切除,术后复发率低,并发症相对较少,值得基层医院推广应用。

Objective To investigate the efficacy and safety of endoscopic subcucosal dissection (ESD) in treatment of colorectal carcinoma in situ and precancerous lesions. Methods The data of 25 patients with colorectal carcinoma in situ and precancerous lesions who were treated with ESD from June 2016 to February 2018 was analyzed and evaluated the safety and efficacy of ESD. Results 25 cases of carcinoma in situ and precancerous lesions ranged from 1.1 ~ 6.9 cm in size with an average of 3.2 cm, and the operation time was 35 ~ 240 minutes with an average of 85 minutes. One-time complete resection of lesions was performed in 21 patients and the complete resection rate was 84.0%(21/25). 3 cases of high-frequency electrical snares were removed by fractionation, and 1 case of intraoperative hemorrhage was transferred to surgery. No perforation occurred in all these cases, delayed bleeding occurred in 2 cases, and endoscopic hemostasis was successful. All these patients were followed up for 3 months and the wound healing rate was 100.0%. The average follow-up period was 6 months and there was no residual or recurrence locally. Conclution ESD is a safe and effective treatment for the treatment of colorectal carcinoma in situ and precancerous lesions, which is worth clinical extension.