结肠微小病变精确定位的研究分析

The study of accurate location of colonic minimal lesion

摘要:

摘要：由于近年内镜技术的发展及普及，结直肠息肉和早期结直肠癌肿等病变的检出率越来越高，对预后的改善起到了至关重要的作用。许多局限在黏膜和黏膜下的病变可以被早期发现并在内镜下切除，但浸入肌层后内镜下往往不能切除，需要经腹腔镜或开腹手术切除。然而术前肠镜定位不准确时有发生（该院病例统计术前肠镜检查报告与术中病变描述符合率不足30%），并且微小病变肠壁缺乏特异性的表现，术中定位困难，手术的难度比较大；而腹腔镜手术因为缺少手的触感，使得手术时间更长，难度更大。因此，术前如何精确定位结肠的微小病变是目前外科界的一大难题，国内外学者为此尝试了许多方法，有术中内镜检查、碳染料标记及金属夹标记等，该文对这些方法做一综述。

Abstract:

Abstract: As the development and adhibition of the endoscope technique, the rate of diagnosis for early cancer and polyps in the rectum and colon is significant increased, thus patients’ prognosis is improved. Resection for the neoplasms on the mucosa and submucosa can be made with endoscope. However, patients have to take a laparotomy or laparoscopic surgery while the neoplasms invade the lamina muscularis or deeper. With the help of the endoscopy, the lesion still cannot be positioned accurately. In our hospital, the coincidence rate is less than 30% between endoscopy diagnosis and surgery diagnosis. It is difficult to find the minimal lesion on the intestinal wall without characteristic symptom, especially for the laparoscopic surgery. Therefor, how to get accurate positioning is still a challenge by domestic and overseas scholars. This review will focus on the reported methods such as: mark with metal clip, carbon dye and endoscopy during operation time.