内镜下黏膜染色联合黏膜下切除术治疗无蒂型大肠腺瘤的应用

为探讨基层医院常规电子大肠镜下黏膜染色联合黏膜下切除术治疗无蒂型大肠腺瘤的可行性，对26例符合条件的大肠扁平隆起、平坦、凹陷型及广基浅表性病变患者用0．4％靛胭脂直接喷洒行黏膜染色；染色后于肠镜下观察病灶腺窝开口类型；按鹤田分类法判断浅表性大肠腺瘤小凹形状；局部黏膜注射1：10000肾上腺素，或其中加入少许美蓝、甘油果糖；根据黏膜“隆起征”判断是否行黏膜切除术；观察切除率及并发症。结果显示，26例患者中一次性切除22例，分次切除4例。1例内镜治疗后便血，行急诊大肠镜检查电灼后止血。2例黏膜层癌变，其中1例患者内镜治疗后仍要求外科手术治疗，术后经病理组织学检查均未发现癌残留及淋巴结转移；另1例长期内镜随访24个月，未见局部复发及转移。所有患者均无治疗后肠穿孔、感染。结果表明，使用普通电子内镜染色也可使病灶范围显示清楚，同时观察腺管开口，判断是否黏膜下切除肿瘤，其是一种简单、安全、有效的方法。

Application of Endoscopic Mucosa Staining plus Submucous Resection in the Treatment of Pedicle-free Colorectal Adenoma

Twenty six patients with colorectal adenoma,which are thin flat and projection, flat,pit and wide base superfical lession were recruited in the study, author attempted to explore the feasibility of the following combination therapy for pedicle-free colorectal adenoma,in which 0.4 % Indicarmine was sprayed on the rnucosa for staining; the type of adenomatous orifice was observed endoscopically; according to the He Tian＇s classification to judge the small superfical pit of colorectal adenoma~the feature of the colorectal adenoma was determined; local mucosal injection of Adrenaline（1 ： 10000）（small amount of Methylene blue and Glycerin fructose might he added） ;mucosa resection or not was conducted according to the determina- tion of the colorectal mucosal projection sign; and the resection rate and complications were observed. As results,primary resection was done in 22 cases and fractional resection in the rest 4 cases. One was subjec- ted to fulguration for hematochezia following endoscopic treatment. Mucosal cancerization was found in 2 cases among whom one received radical treatment then the pathologic-histologic examination had not dis- covered residual cancer lesion and lymph node metastasis, rest one no recurrence or metastasis were noticed in the follow up for 24 months. No postoperative perforation or infection occurred in all the patients. It is concluded that common video endoscopic mucosa staining could let the lesion area display clear,at the same time observing the aderomatous orifice, to judge whether resect the tumor submucous,and it is an effective, simple and safe method.