摘要
目的研究内镜反转黏膜切除术(retroflex endoscopic mucosal resection,REMR)对大型超低位直肠侧向发育型肿瘤的治疗效果,并对其适应症、并发症和操作方法等问题进行讨论。方法选择直径大于3.0cm,肿瘤下缘距肛缘齿状线小于2cm,有内镜治疗适应证的18例超低位直肠侧向发育型肿瘤,应用内镜反转黏膜切除术(REMR)进行肿瘤切除,术后3～24个月行内镜随访确认有无残留,以评价切除效果,记录术中及术后发生的并发证及处理情况,并分析切除标本的病理组织学结果。结果接受REMR治疗的18例,平均手术时间为46.4min,其中16例经首次或再次REMR治疗病变完整清除,肛门功能完好,保肛治愈率为88.9%,术后病理报告浸润癌(SM癌)再追加外科根治手术者1例(5.6%);因病变残留转外科行经腹会阴联合切除手术者1例(5.6%)。并发症:本组18例术中平均出血20ml,最大出血160ml,均无需输血治疗,无穿孔发生,无术后并发症。结论内镜反转黏膜切除术是一种安全微创的内镜治疗手段,对大多数接近齿状线的超低位直肠侧向发育型肿瘤能达到完全切除效果,并可完美保全肛门功能。
Objective To investigate the （REMR） for large-sized laterally spreading tumors curative effect of retroflex endoscopic mucosal resection in the super-low rectum and the applications, complications, and techniques of this procedure. Methods A total of 17 patients with tumor size more than 3.0 cm and tumors located less than 2.0 cm to the anus were included in this study. REMR was performed by means of en bloc or piecemeal snare cut method. A follow-up period for 3-24 months was conducted to evaluate the curative effect. The rates of complications and following treatments were recorded. All resected specimens were retrieved for pathological study. Results REMR was performed in 18 patients. Tumors in 16 patients were completely removed after one-time or multiple REMR procedures with satisfactory anal function retained in 16 patients. The curative rate was 88.8%. There were no remnants or recurrence of tumors during the follow-up period. One patient underwent Mile＇ s operation because of invasive cancer after REMR confirmed pathologically and another patient also underwent Mile＇ s operation due to tumor residual after REMR. Complications included 20 ml of average bleeding and 160 ml of maximum bleeding. No blood transfusion was employed in all patients. No perforation nor other complications occurred after REMR procedures. Conclusion REMR is a safe and minimally invasive therapy for the treatment of super-low rectal tumors due to its radical resection of the majority of low rectal benign tumors and satisfactory retained anus function.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2009年第16期1545-1548,共4页
Journal of Third Military Medical University
关键词
内镜反转黏膜切除术
低位直肠
侧向发育型肿瘤
retroflex endoscopic mucosal resection
super-low rectum
laterally spreading tumor
