[1]刘思德,张亚历,周丹,等.内镜反转黏膜切除术治疗大型超低位直肠侧向发育型肿瘤18例临床应用[J].第三军医大学学报,2009,31(16):1545-1548.
 LIU Si-de,ZHANG Ya-li,ZHOU Dan,et al.Retroflex endoscopic mucosal resection for laterally spreading tumors in the super-low rectum[J].J Third Mil Med Univ,2009,31(16):1545-1548.
点击复制

内镜反转黏膜切除术治疗大型超低位直肠侧向发育型肿瘤18例临床应用(/HTML )
分享到:

《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
31卷
期数:
2009年第16期
页码:
1545-1548
栏目:
专题报道
出版日期:
2009-08-30

文章信息/Info

Title:
Retroflex endoscopic mucosal resection for laterally spreading tumors in the super-low rectum
作者:
刘思德张亚历周丹万田谟陈村龙潘德寿张振书智发朝周殿元姜泊
南方医科大学附属南方医院消化内科
Author(s):
LIU Si-de ZHANG Ya-li ZHOU Dan WAN Tian-mo CHEN Cun-long PAN De-shou ZHANG Zhen-shu ZHI Fa-chao ZHOU Dian-yuan JIANG Bo
Department of Gastroenterology, Southern Hospital, Nanfang Medical University, Guangzhou 510515, China
关键词:
内镜反转黏膜切除术低位直肠侧向发育型肿瘤
Keywords:
retroflex endoscopic mucosal resection super-low rectum laterally spreading tumor
分类号:
R574;R730.56;R735.37
文献标志码:
A
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3.0 cm,肿瘤下缘距肛缘齿状线小于2 cm,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46.4 min,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20 ml,最大出血160 ml,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。
Abstract:
Objective   To investigate the curative effect of retroflex endoscopic mucosal resection (REMR) for large-sized laterally spreading tumors 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.

参考文献/References:

刘思德,张亚历,周丹,等.内镜反转黏膜切除术治疗大型超低位直肠侧向发育型肿瘤18例临床应用[J]. 第三军医大学学报,2009,31(16):1545-1548.

更新日期/Last Update: 2009-09-07