【摘要】 目的研究内镜下黏膜切除术对平坦型大肠肿瘤的治疗效果,并对其适应证、并发症和操作方法等问题进行讨论。方法有内镜治疗适应证的546例共602处平坦型大肠肿瘤,应用注射法或透明帽辅助法黏膜切除术进行治疗,共切除602个病变,术后定期内镜随访6～73个月,以评价切除效果,记录术中及术后发生的并发症及处理情况,并分析切除标本的病理组织学结果。结果602处病变中588处病变经首次或再次EMR治疗病变完整清除,治愈率为97.7%,术后病理报浸润癌(SM2癌)再追加外科手术者8例(1.3%),因严重并发症(迟发性大出血)转外科手术者2例(0.3%),因病变残留转行外科手术者4例(0.7%)。并发症:术中出血17例(3.1%),均内镜下止血成功,术后迟发出血3例,其中2例(0.4%)内镜下止血失败转外科开腹手术。术后局限性腹膜炎4例,经保守治疗治愈。无穿孔发生。术后病理:黏膜内癌(上皮内高级别瘤变)48例,黏膜下浸润癌10例,类癌37例,良性腺瘤440例,良性间质瘤6例,增生性息肉38例,锯齿状腺瘤10例,B细胞淋巴瘤1例,错构瘤1例,其它3例。结论内镜下黏膜切除术是一种安全微创的内镜治疗手段,对大多数平坦型大肠肿瘤能达到完全切除效果。更多还原

【Abstract】 Objective:To investigate the curative effect on endoscopic mucosal resection(EMR) for colorectal flat tumors and to discuss the applications,complications and techniques of this procedure.Methods:A total of 546 patients with 602 lesions were included in this study.EMR were performed by means of en bloc either injection snare cut method.The follow-up period was 6~73 months to evaluate the curative effect.The rates of complications and following treatments were recorded.All resected specimens were retrieved for pathological study.Results:602 lesions were removed in 546 patients.The complete resections in first or follow EMR procedure were performed on 588 out of 602 lesions.The curative rate was 97.7%.There were no remnant or recurrence of tumors during the follow-up of average 27.6 months.There were 8 cases(1.3%) transferred to surgery because of the finding of pathological invasive cancers after EMR,as well as 2 patients(0.3%) with severe complications(delayed bleeding) and 4 patients(0.7%) with residual tumor.The complications as follow:seventeen patients occurred hemorrhage during EMR procedure,but only one patient need for blood transfusion.Three patients occurred delayed hemorrhage and two of them need to surgical intervene.Four cases had local peritonitis after EMR procedure.No perforation occurred.The pathological finding were as follows:440 lesions of benign adenomas 48 lesions of intramucosal carcinoma(high-grade intraepithelial neoplasia),10 lesions of submucosal invasive carcinomas,37 lesions of carcinoids,6 lesions of benign stromal tumors,38 lesions of hyperplasia polyps,10 lesions of serrated adenoma,1 lesions of B cell lymphoma,1 lesions of hamartoma and 3 lesions of others.Conclusion:EMR is a safe and minimally invasive therapy for the treatment of colorectal flat tumor.It can completely resect the majority of colorectal flat tumors.更多还原