内镜黏膜下剥离术治疗大肠侧向发育型肿瘤的临床应用

Clinical Application of Endoscopic Submucosal Dissection in the Treatment of Laterally Spreading Tumors

目的:探讨内镜黏膜下剥离术(ESD)治疗大肠侧向发育型肿瘤(直径≥20 mm)的临床价值。方法:选取2013年1月至2018年1月诊断为大肠侧向发育型肿瘤(直径≥20 mm)30例患者为研究对象,行ESD治疗,记录并分析ESD操作时间、病灶大小、出血及穿孔例数、病理类型、镜下分型、随访结果等指标。结果:内镜下大肠侧向发育型肿瘤形态分型主要以颗粒均一型、结节混合型为主,腺管开口主要以Ⅲ型和IV型两种类型为主。30例大肠侧向发育型肿瘤均经ESD一次性完整切除,病灶直径大小20 mm^35 mm,平均(26.57±4.55)mm;ESD操作时间30 min^180 min,平均(81.57±31.63)min;术中穿孔1例,穿孔例3.3%,经金属钛夹夹闭保守治疗后可恢复,无需外科手术;术中出血2例,经氩离子凝固术(APC)处理后均能止血;30例均无术后迟发性出血。28例患者经3~6月随访,复查肠镜创面恢复良好,均无复发,2例患者失访。结论:对于直径≥20 mm的大肠侧向发育型肿瘤,内镜黏膜下剥离术(ESD)治疗是安全有效的,可以一次性完整切除病灶,出血及穿孔发生率、病灶复发率低,值得临床推广应用。

Objective:To investigate the clinical value of endoscopic submucosal dissection(ESD)in the treatment of laterally spreading tumor(diameter≥20mm).Methods:30 patients diagnosed as laterally spreading tumor(diameter≥20 mm)from January 2013 to January 2018 were selected for ESD treatment,the ESD operation time,lesion size,number of bleeding and perforation,pathological type,microscopic classification and follow-up results and other indicators were recorded and analyzed.Results:The main morphological types of laterally spreading tumor under endoscopy were Homogeneous granule and mixed nodule,and the main types of glandular duct opening were type III and IV.30 cases of laterally spreading tumor were completely resected by ESD at one time,the diameter of lesions was 20 mm^35 mm,with an average of(26.57±4.55)mm;the operation time of ESD was 30mm^180min,with an average of(81.57±31.63)min;1 case of perforation during operation,with 3.3%of perforation,could be recovered after conservative treatment with metal-titanium clip without surgical operation;2 cases of bleeding during operation,could be stopped after APC treatment;30 cases had no delayed bleeding after operation.28 patients were followed up from 3 to 6 months,which were well recovered without recurrence by rechecking colonoscopy,and 2 patients were lost the follow-up.Conclusions:Endoscopic submucosal dissection(ESD)in the treatment of laterally spreading tumor(diameter≥20 mm)is safe and effective,and can be completely resected at one time with a low incidence of bleeding and perforation and recurrence rate,which is worthy of clinical popularization and application.