口袋法内镜黏膜下剥离术对早期结直肠癌及其癌前病变的疗效评价

Therapeutic efficacy of endoscopic submucosal dissection with pocket-creation method for early colorectal carcinoma and precancerous lesions

摘要:

摘要：目的??探讨口袋法内镜黏膜下剥离术（ESD）治疗早期结直肠癌及其癌前病变的临床疗效。方法?收集2017年4月－2018年12月该院消化内科收治的23例早期结直肠癌及其癌前病变患者，通过口袋法ESD术治疗，记录临床相关数据，进行回顾性分析。结果?切下的23例病变最长径1.8～4.5 cm；手术时间为25.0～140.0 min；无术中明显出血及迟发性出血病例；无术中和迟发性穿孔病例；整块切除率为100.0%；术后病理显示，腺瘤伴低级别上皮内瘤变14例，腺瘤伴高级别上皮内瘤变6例，腺瘤伴黏膜内癌2例，水平及垂直切缘均阴性，完全切除率95.7%（22/23），而1例术后病理示腺瘤伴高级别上皮内瘤变，局灶癌变伴黏膜下浸润，垂直切缘阳性，追加外科手术；随访时所有患者未见局部复发和远处转移，治愈性切除率为95.7%。结论?口袋法ESD术治疗早期结直肠癌及其癌前病变安全且有效。

Abstract:

Abstract: Objective?To explore the clinical effect of endoscopic submucosal dissection (ESD) with pocket-creation method for early colorectal carcinoma and precancerous lesions.?Methods?ESD with pocket-creation method was applied to 23 patients with early colorectal carcinoma and precancerous lesions from April 2017 to December 2018. The clinical data were recorded and analyzed retrospectively.?Results?The longest diameter of the lesions was 1.8 ~ 4.5 cm; The operating time was 25.0 ~ 140.0 min; no intraoperative bleeding or delayed bleeding; no intraoperative or delayed perforation; the resection rate of the en block was 100.0%. Postoperative pathological evaluation showed that 14 cases of adenoma with low-grade intraepithelial neoplasia, 6 cases of adenoma with high-grade intraepithelial neoplasia, 2 cases of adenoma with intramucosal carcinoma, negative horizontal and vertical incision margins. The complete resection rate was 95.7% (22/23). 1 case of adenoma with high-grade intraepithelial neoplasia, local carcinogenesis with submucosal infiltration, positive vertical incision margin, and additional surgery were performed. No local recurrence or distant metastasis was found in all follow-up patients, and the cure resection rate was 95.7%.?Conclusion?ESD with pocket-creation method is safe and effective in the treatment of for early colorectal carcinoma and precancerous lesions.