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目的探讨内镜反转黏膜切除术治疗超低位直肠大型侧向发育型肿瘤的价值。方法回顾性分析四川大学华西医院消化内镜中心2010年1月-2011年12月间38例内镜反转黏膜切除术治疗超低位直肠大型侧向发育型肿瘤病变残留、治疗效果。结果 38例患者,男18例,女20例,年龄8～80岁;病变下缘距肛门齿状线1～4.0 cm24例,侵及齿状线14例。病变大小(按病变最大径分类):1.5～3.0 cm 12例,3.1～4.0 cm 8例,4.1～5.0 cm4例,5.1～7.0 cm 10例,10 cm 4例。病变直径在5.0 cm以下的24例患者,经首次手术治疗肿瘤完整切除,术后2例灶性癌变,追加外科手术;其余22例2个月复查,病变无残留,6个月复查,2例复发,经再次手术病变完整切除。随访1年,全部未见复发,治愈率为100%,无残留。病变直径5.1～7.0cm的10例患者,经首次手术治疗肿瘤分次切除,2个月复查,6例病变完整切除无残留,6个月复查,其中2例复发,经再次内镜下手术切完病变,随访1年,无复发;另4例有残留,经再次内镜下手术切完病变,6个月复查无复发,随访1年,4例均未见复发。病变直径10 cm的4例患者,经多次手术后复查均有病变残留,无法完全切除,患者拒绝外科手术。5.1 cm以上病变治愈率71.43%,残留率高达57.14%。本组术后出血16例,感染1例,直肠狭窄1例,肛门坠胀3例,无穿孔发生。结论内镜反转黏膜切除术治疗超低位直肠大型侧向发育型肿瘤有效,对5.0 cm以下病变能一次完整切除,5.1 cm以上病变残留率高,需再次内镜下手术,10 cm以上病变切除不完全。应慎重选择病例,术后密切随访。
Objective To investigate the value of endoscopic inversion mucosal resection in the treatment of ultra-low rectum large lateral developmental tumors. Methods Retrospective analysis of 38 cases of endoscopic retrospective mucosal resection for the treatment of ultra-low rectal large lateral developmental tumor lesions in West China Hospital of Sichuan University from January 2010 to December 2011 were retrospectively analyzed. Results 38 patients, 18 males and 20 females, aged 8 to 80 years; lower edge of the lesion from the anal dentate line 1 ~ 4.0 cm24 cases, invaded dentate line in 14 cases. The size of lesion (classified according to the diameter of the lesion) included 12 cases of 1.5-3.0 cm, 8 cases of 3.1-4.0 cm, 4 cases of 4.1-5.0 cm, 10 cases of 5.1-7.0 cm and 4 cases of 10 cm. Twenty-four patients under the diameter of 5.0 cm had complete tumor resection after the first operation, 2 cases of focal canceration after operation, and additional surgery. The remaining 22 patients were examined for 2 months without any residual disease and were followed up for 6 months. Two patients Recurrence, the complete removal of the surgical lesions again. Followed up for 1 year, all without recurrence, the cure rate was 100%, no residue. The diameter of the lesion 5.1 ~ 7.0cm in 10 patients, after the first surgical treatment of tumor subtotal resection, 2 months of review, 6 cases of complete resection without residual disease, 6 months review, of which 2 cases of recurrence after endoscopic resection End of disease, follow-up of 1 year, no recurrence; the other 4 cases were residual after endoscopic resection of lesions, 6 months no recurrence, followed up for 1 year, 4 cases were no recurrence. Four patients with a diameter of 10 cm had residual disease after multiple surgeries and could not be completely resected. The patient refused surgery. 5.1 cm above the cure rate of 71.43% lesions, the residual rate of up to 57.14%. The group of postoperative bleeding in 16 cases, 1 case of infection, 1 case of rectal stenosis, anal ankle swelling in 3 cases, no perforation. Conclusions Endoscopic reverse mucosal resection is effective in treating large, laterally rectal tumors of the ultra-low rectal size. One complete resection of the lesion less than 5.0 cm can be performed. The residual rate of 5.1 cm or more lesions is high. Surgical resection of the lesion beyond 10 cm is required incomplete. Should be carefully selected cases, follow-up after surgery.