内镜下切除盲肠近阑尾口病变10例临床分析

Endoscopic resection of cecal lesions involving appendiceal orifice in 10 cases

目的探讨内镜下切除盲肠近阑尾口病变的安全性及治疗效果。方法盲肠近阑尾口病变患者10例,术前均行超声内镜检查确定病灶位置及病灶大小,行内镜下圈套器切除术或内镜下黏膜切除术,术后切除标本行组织病理检查。观察内镜下病变组织切除情况、术中及术后并发症发生情况;术后6~12个月,复查结肠镜,观察阑尾口狭窄及残余病变情况;随访3~51个月,观察患者胃肠道不适发生情况。结果10例患者术前超声内镜检查显示病变均起源于黏膜下层或固有肌层,病灶直径为7.7~27.6 mm。8例行内镜下圈套器切除术,2例行内镜下黏膜切除术,术中均未发生出血、穿孔并发症,术后均未出现发热、穿孔、迟发性出血等并发症;术后组织病理检查结果显示潴留性囊肿8例,单纯性黏液囊肿1例,脂肪瘤1例。术后6~12个月,8例患者复查结肠镜,均未发现阑尾口狭窄及残余病变;中位随访时间42个月,10例患者均未出现腹痛等胃肠道不适症状。结论内镜下切除盲肠近阑尾口病变安全、有效,创伤小,并发症少。

Objective To evaluate the safety and outcome of endoscopic resection of cecal lesions involving the appendiceal orifice.Methods Ten patients with cecal lesions involving the appendiceal orifice received endoscopic ultrasonography to determine the location and size of the lesions,then underwent endoscopic snaring resection or endoscopic mucosal resection.Histopathological examination was done in all resected specimens.The endoscopic en bloc resection rate,and incidences of intraoperative and postoperative complications were observed.In 6 to 12 months after endoscopy,colonoscopy was performed to observe the stenosis and residual lesions of the appendiceal orifice.The patients were followed up for 3 to 51 months to observe the occurrence of gastrointestinal discomfort.Results Preoperative endoscopic ultrasonography showed that all lesions were subepithelial,with a diameter of 7.7 to 27.6 mm.In 10 patients,8 received endoscopic snaring resection and 2 received endoscopic mucosal resection.No intraoperative complications as bleeding or perforation occurred,and no postoperative complications as fever,perforation or delayed bleeding occurred.Postoperative histopathological diagnoses included 8 cases of retention cyst,1 of mucocele,and 1 of lipoma.In 6 to 12 months after operation,8 patients underwent colonoscopy,showing no appendiceal stenosis or residual lesions.The median follow-up time was 42 months,and no gastrointestinal discomfort was found.Conclusion Endoscopic resection of cecal lesions involving the appendiceal orifice is safe and effective,and it has less trauma and few complications.