改良的圈套器行内镜黏膜下剥离术切除结直肠息肉及黏膜下肿瘤的疗效评价

发布时间：2018-03-29 01:05

本文选题：圈套器　切入点：结直肠息肉　出处：《中国内镜杂志》2017年02期

【摘要】：目的探讨改良的圈套器行内镜黏膜下剥离术(ESD)切除结直肠息肉及黏膜下肿瘤的安全性、有效性。方法回顾性研究2014年12月-2016年5月利用改良的圈套器完成ESD切除结直肠息肉、神经内分泌肿瘤(NETs)和间质瘤患者的临床资料,探讨改良的圈套器进行ESD术治疗结直肠病变的安全性、有效性、治疗时间和并发症等,并与HOOK刀完成ESD术进行比较。结果共20例病例24处入选并完成ESD术,其中16例病例共20处病灶均顺利完成改良的圈套器行ESD术(实验组),4例病灶采用传统HOOK刀完成ESD术(对照组)。两组手术成功率均为100.0%,病灶整块切除率100.0%(24/24);实验组息肉长径为1.2~4.0 cm,平均长径(2.4±0.9)cm,对照组息肉长径为1.5~3.0 cm,平均长径(2.2±0.6)cm;实验组手术时间为45.0~120.0 min,平均时间(83.3±23.9)min,对照组手术时间45.0~80.0 min,平均时间(66.2±15.4)min,与对照组比较,实验组耗时长,差异具有统计学意义(P=0.038)。术后病理:结直肠腺瘤15例(其中3例腺瘤伴局部腺体高级别上皮内瘤变),增生性息肉1例,高级别上皮内瘤变1例,NETs 2例共4处病灶,间质瘤1例,两组中除1例来源于固有肌层间质瘤全层切除术以外,无1例出现出血、穿孔、感染等并发症,无1例术中、术后转外科治疗。结论改良的单圈套器能够安全、有效地完成ESD术切除巨大结直肠息肉及黏膜下肿瘤,拓展了圈套器在内镜切除术中的使用方法及适应证,但需要更长时间来完成手术。
[Abstract]:Objective to investigate the safety and efficacy of endoscopic submucosal dissection (ESD) for the resection of colorectal polyps and submucosal tumors with modified trap. Methods ESD was used to remove colorectal polyps from December 2014 to May 2016. The clinical data of patients with neuroendocrine neoplasms (NETs) and stromal tumors were studied to investigate the safety, efficacy, treatment time and complications of ESD for colorectal lesions. The results were compared with that of ESD performed by HOOK knife. Results A total of 20 cases with 24 cases were selected and completed ESD operation. In 16 cases, 20 lesions were successfully performed with ESD. (in the experimental group, 4 cases underwent ESD with traditional HOOK knife (control group). The success rate of operation in both groups was 100.00.The resection rate of the whole lesion was 100.024 / 24; the experimental group was treated with ESD. The mean length of meat was 1.2cm., the average length was 2.4 卤0.9cm, the average length of polyp was 1.5 卤3.0 cm, the mean length of polyp was 2.2 卤0.6cm, the operative time was 45.0 min (120.0 min), the average time was 83.3 卤23.9min, and the control group was 45.0 min (66.2 卤15.4min), compared with the control group, the operation time of the control group was 45.0 卤23.9min, the mean time of the control group was 66.2 卤15.4min, and the operation time of the control group was 66.2 卤15.4min. There were 15 cases of colorectal adenoma (3 cases of adenoma with local high grade intraepithelial neoplasia, 1 case of proliferative polyp, 1 case of high grade intraepithelial neoplasia) and 2 cases of high grade neoplasia of NETs. There was 1 case of stromal tumor in both groups, except one case originated from the total excision of muscular stromal tumor of the propria, no case had complications such as hemorrhage, perforation and infection, and no case was transferred to surgery after operation. Conclusion the modified single trap device is safe. ESD is effective in the removal of large colorectal polyps and submucosal tumors, which extends the use and indications of the snare in endoscopic resection, but it takes longer to complete the operation.
【作者单位】：安徽医科大学第二附属医院消化内科;
【基金】：安徽省自然科学基金(No:1408085MH178)
【分类号】：R735.34

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