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目的评价预切开内镜黏膜切除术(Pre-cut-EMR)治疗大肠侧向发育型肿瘤(LST)的临床疗效。方法从2014年1月-2014年12月,共有65例直径>2.0 cm的LST病变纳入研究,治疗前采用染色放大内镜或内镜窄带成像技术(NBI)观察病灶黏膜,完成内镜评估和病理诊断证实符合内镜下治疗指证。研究分析LST病灶直径、病灶部位、内镜分型和病理结果,统计观察手术时间、整块切除率、完全切除率、并发症及术后复发情况,随访观察治疗的临床效果及安全性。结果 65例结肠LST肿瘤直径2.0~5.0 cm,平均直径(2.4±1.7)cm,病灶部位直肠28例(43.1%),乙状结肠11例(16.9%),降结肠6例(9.2%),结肠脾曲2例(3.1%),横结肠9例(13.8%),结肠肝曲4例(6.2%),升结肠2例(3.1%),盲肠3例(4.6%)。LST内镜分型中形态呈颗粒均一型23例(35.4%),结节混合型27例(41.5%),扁平隆起型13例(20.0%),假凹陷型2例(3.1%);LST病理结果 :管状腺瘤12例(18.5%),管状绒毛状腺瘤19例(29.2%),绒毛状腺瘤26例(40.0%),高级别上皮内瘤变7例(10.7%),黏膜内癌1例(1.5%)。65例LST病灶均应用Pre-cut-EMR成功切除,手术时间20~45 min,平均时间(18.0±11.7)min,整块切除率100.0%,完全切除率100.0%,术中即刻出血5例(7.7%),术后7天内迟发出血1例(1.5%),无1例发生穿孔。术后随访3~6个月,复查肠镜所有病例均无复发。结论应用Pre-cut-EMR能完全切除直径>2.0 cm的LST病变,且安全有效。
Objective To evaluate the clinical efficacy of pre-cut-EMR in the treatment of colorectal tumor (LST). Methods From January 2014 to December 2014, a total of 65 LST lesions> 2.0 cm in diameter were enrolled in the study. Before treatment, the lesion mucosa was observed by staining magnifying endoscopy or endoscopic narrow band imaging (NBI) Pathological diagnosis confirmed in line with endoscopic treatment of evidence. The diameter, lesion site, endoscopic classification and pathological findings of LST lesion were analyzed. The operation time, lump resection rate, complete resection rate, complications and postoperative recurrence were observed. The clinical effect and safety were observed. Results The diameter of colorectal cancer in 65 patients was 2.0-5.0 cm (2.4 ± 1.7 cm in diameter), 28 (43.1%) were rectal lesions, 11 (16.9%) were sigmoid colon, 6 (9.2% There were 2 cases (3.1%) of the song, 9 cases (13.8%) of the transverse colon, 4 cases (6.4%) of the liver of the colon, 2 cases of ascending colon (3.1%) and 3 cases of cecum (4.6%). There were 23 cases (35.4%) with homogenized granules, 27 cases (41.5%) with nodular mixed type, 13 cases (20.0%) with flattened protuberance and 2 cases (3.1%) with pseudo- Pathological findings included tubular adenoma in 12 cases (18.5%), tubular villous adenoma in 19 cases (29.2%), villous adenoma in 26 cases (40.0%), high grade intraepithelial neoplasia in 7 cases (10.7%), mucosa One case of intracarcinoma (1.5%). Sixty-five patients with LST were successfully resected with Pre-cut-EMR. The operation time was 20-45 min, the average time was 18.0 ± 11.7 min, the total resection rate was 100.0%, the complete resection rate was 100.0% 7.7%). One patient (1.5%) had delayed bleeding within 7 days after operation. No patient had perforation. All cases were followed up for 3 to 6 months. No recurrence was found in all cases of colonoscopy. Conclusion Pre-cut-EMR can completely resect LST lesions> 2.0 cm in diameter and is safe and effective.