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目的探讨内镜黏膜切除术(EMR)在结直肠肿瘤中的临床应用价值。方法对2001年4月至2006年5月我院肠镜下行EMR治疗的19例(29个病变)患者的临床资料进行回顾分析。结果29个病灶中直接用圈套器切除26个,用透明帽切除3个;病灶大小为0.6 cm×0.6 cm~6.0 cm×10 cm,均为扁平病灶;24个病灶1次切除,1个病灶2次分割切除,1个病灶10次分割切除,1个病灶80余次分割切除,2个未能完全切除;27个病灶取到组织送病理检查,证明完全切除25个,完全切除率为92.6%(25/27)。内镜下分型:隆起型(Ⅰ型)6个,其中亚蒂型(Ⅰsp)1个,无蒂型(Ⅰs)5个;平坦型(Ⅱ型)23个,其中平坦隆起型(Ⅱa)16个,平坦隆起+平坦凹陷型(Ⅱa+Ⅱc)2个,表面平坦型(Ⅱb)5个。组织学分型:早期癌3个,重度不典型增生9个,中度不典型增生12个,单纯腺瘤3个。术前病理检查结果与术后病理检查结果对照相符者16例,占59.3%,不相符者占40.7%。未发生大出血或穿孔等严重并发症。有5个病灶切除后出现少量渗血。结论EMR治疗结直肠早期癌和癌前病变方法简单,可完全切除病灶,并发症少。
Objective To investigate the clinical value of endoscopic mucosal resection (EMR) in colorectal neoplasms. Methods The clinical data of 19 patients (29 lesions) undergoing EMR in our hospital from April 2001 to May 2006 were retrospectively analyzed. Results Twenty-nine lesions were directly excised with a snare and three with a transparent cap. The size of the lesion was 0.6 cm × 0.6 cm-6.0 cm × 10 cm, all of which were flat lesions. One of 24 lesions was excised and one was lesioned 2 sub-cut, a lesion divided 10 times, a lesion divided more than 80 times, 2 failed to completely resect; 27 lesions were taken to send tissue biopsy, 25 cases were completely resected, the complete resection rate was 92.6 % (25/27). There were 6 type Ⅰ (type Ⅰ) and 5 type Ⅰs (type Ⅰs), 23 type Ⅱ (type Ⅱa) 16, flat uplift + flat depression (Ⅱa + Ⅱ c) 2, flat surface (Ⅱ b) 5. Histological typing: early cancer 3, severe atypical hyperplasia 9, moderate atypical hyperplasia 12, simple adenoma 3. The results of preoperative pathological examination and postoperative pathological findings were consistent with the control of 16 cases, accounting for 59.3%, 40.7% did not match. No major bleeding or perforation and other serious complications. A small amount of oozing occurred after resection of 5 lesions. Conclusion EMR treatment of early colorectal cancer and precancerous lesions method is simple, complete removal of the lesion, fewer complications.