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目的:探讨大肠粘膜内癌内镜下局部治疗的近期和远期效果。方法:对近5年发现的42例大肠粘膜内癌采用活检钳咬除、肛镜下枪式套扎器套扎、圈套高频电切一种或几种方法相互结合进行局部治疗,术后1月～3年用电子结肠镜复查。结果:(1)18例用活检钳全部摘除,3例枪式套扎器套扎,16例圈套高频电切,5例采用多种方法相互结合。(2)有5例同时合并另一进展期癌肿,除1例拒绝手术,1例病期太晚失去手术时机,3例作了扩大根治切除;其余37例中,有7例追加外科手术治疗,切除的肠标本上未发现癌残留。(3)33例(其中未追加手术30例)随访1月～5年,未发现癌复发。(4)随访病例中,14例癌伴多发性腺瘤在术后1～3年新生腺瘤发生率57.1%(8/14);而单发早期癌同期新生腺瘤发生率15.8%(3/19)。结论:只要病例选择合适,大肠粘膜内癌经内镜局部切除是可以达到治愈的,而且安全和微创。
Objective: To investigate the short-term and long-term effects of local treatment of endoscopic mucosal colon cancer. Methods: Forty-two cases of colorectal mucosal cancers found in the past 5 years were treated with biopsy forceps, anal lens gun-ligand ligation, and high-frequency electric snares combined with one or more methods for local treatment. January to 3 years were reviewed with electronic colonoscopy. Results: (1) 18 cases were completely removed with biopsy forceps, 3 cases were tied with gun-type ligation device, 16 cases were treated with high frequency electrocution, and 5 cases were combined with multiple methods. (2) There were 5 cases with another advanced stage cancer at the same time, except one case refused surgery, one case was too late to lose the timing of surgery, three cases had extended radical resection, and the remaining 37 cases had additional surgery. After treatment, no residual cancer was found on the resected intestinal specimens. (3) 33 cases (30 cases without additional surgery) were followed up for 1 month to 5 years and no cancer recurrence was found. (4) In the follow-up cases, the incidence of new adenomas in 1 to 3 years after operation was 57.1% (8/14) in 14 cases of multiple adenomas with cancer, and the rate of single-phase early neo-adenocarcinomas was 15.8% (3/3). 19). Conclusion: As long as the appropriate case selection, endoscopic local resection of colorectal mucosal cancer can be cured, and safe and minimally invasive.