本文選題：圈套器　切入點：結(jié)直腸息肉　出處：《中國內(nèi)鏡雜志》2017年02期

【摘要】：目的探討改良的圈套器行內(nèi)鏡黏膜下剝離術(ESD)切除結(jié)直腸息肉及黏膜下腫瘤的安全性、有效性。方法回顧性研究2014年12月-2016年5月利用改良的圈套器完成ESD切除結(jié)直腸息肉、神經(jīng)內(nèi)分泌腫瘤(NETs)和間質(zhì)瘤患者的臨床資料,探討改良的圈套器進行ESD術治療結(jié)直腸病變的安全性、有效性、治療時間和并發(fā)癥等,并與HOOK刀完成ESD術進行比較。結(jié)果共20例病例24處入選并完成ESD術,其中16例病例共20處病灶均順利完成改良的圈套器行ESD術(實驗組),4例病灶采用傳統(tǒng)HOOK刀完成ESD術(對照組)。兩組手術成功率均為100.0%,病灶整塊切除率100.0%(24/24);實驗組息肉長徑為1.2~4.0 cm,平均長徑(2.4±0.9)cm,對照組息肉長徑為1.5~3.0 cm,平均長徑(2.2±0.6)cm;實驗組手術時間為45.0~120.0 min,平均時間(83.3±23.9)min,對照組手術時間45.0~80.0 min,平均時間(66.2±15.4)min,與對照組比較,實驗組耗時長,差異具有統(tǒng)計學意義(P=0.038)。術后病理:結(jié)直腸腺瘤15例(其中3例腺瘤伴局部腺體高級別上皮內(nèi)瘤變),增生性息肉1例,高級別上皮內(nèi)瘤變1例,NETs 2例共4處病灶,間質(zhì)瘤1例,兩組中除1例來源于固有肌層間質(zhì)瘤全層切除術以外,無1例出現(xiàn)出血、穿孔、感染等并發(fā)癥,無1例術中、術后轉(zhuǎn)外科治療。結(jié)論改良的單圈套器能夠安全、有效地完成ESD術切除巨大結(jié)直腸息肉及黏膜下腫瘤,拓展了圈套器在內(nèi)鏡切除術中的使用方法及適應證,但需要更長時間來完成手術。
[Abstract]:Objective to investigate the safety and efficacy of endoscopic submucosal dissection (ESD) for the resection of colorectal polyps and submucosal tumors with modified trap. Methods ESD was used to remove colorectal polyps from December 2014 to May 2016. The clinical data of patients with neuroendocrine neoplasms (NETs) and stromal tumors were studied to investigate the safety, efficacy, treatment time and complications of ESD for colorectal lesions. The results were compared with that of ESD performed by HOOK knife. Results A total of 20 cases with 24 cases were selected and completed ESD operation. In 16 cases, 20 lesions were successfully performed with ESD. (in the experimental group, 4 cases underwent ESD with traditional HOOK knife (control group). The success rate of operation in both groups was 100.00.The resection rate of the whole lesion was 100.024 / 24; the experimental group was treated with ESD. The mean length of meat was 1.2cm., the average length was 2.4 鹵0.9cm, the average length of polyp was 1.5 鹵3.0 cm, the mean length of polyp was 2.2 鹵0.6cm, the operative time was 45.0 min (120.0 min), the average time was 83.3 鹵23.9min, and the control group was 45.0 min (66.2 鹵15.4min), compared with the control group, the operation time of the control group was 45.0 鹵23.9min, the mean time of the control group was 66.2 鹵15.4min, and the operation time of the control group was 66.2 鹵15.4min. There were 15 cases of colorectal adenoma (3 cases of adenoma with local high grade intraepithelial neoplasia, 1 case of proliferative polyp, 1 case of high grade intraepithelial neoplasia) and 2 cases of high grade neoplasia of NETs. There was 1 case of stromal tumor in both groups, except one case originated from the total excision of muscular stromal tumor of the propria, no case had complications such as hemorrhage, perforation and infection, and no case was transferred to surgery after operation. Conclusion the modified single trap device is safe. ESD is effective in the removal of large colorectal polyps and submucosal tumors, which extends the use and indications of the snare in endoscopic resection, but it takes longer to complete the operation.
【作者單位】： 安徽醫(yī)科大學第二附屬醫(yī)院消化內(nèi)科;
【基金】：安徽省自然科學基金(No:1408085MH178)
【分類號】：R735.34

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本文編號：1678849