大肠侧向发育型肿瘤内镜下诊治分析

目的 探讨大肠侧向发育型肿瘤(laterally spreading tumor,LST)内镜下的诊断与治疗.方法 我院自2008年9月～2010年12月在肠镜检查过程中同时应用染色内镜和放大内镜检查发现大肠LST 27例,对于直径<20 mm行内镜下黏膜切除术(endoscopic mucosal resection,EMR),直径≥20 mm或腺管开口V型的行内镜下黏膜剥离术(endoscopic submucosal dissection,ESD).术后切除病灶均送病理检查,半年后复查肠镜.结果 大肠LST 27例,检出率为0.92%.行EMR治疗15例,术后无出血、穿孔,半年复查创面愈合良好、无复发.行ESD治疗12例,其中2例术中出现大出血,内镜下止血成功,术后未再出血,无穿孔,半年复查创面愈合良好、无复发.结论 染色内镜及放大内镜可提高大肠LST的检诊率;EMR治疗大肠LST安全、有效,但存在一定的局限性,ESD可作为LST的补充治疗手段.

Endoscopic Diagnosis and Treatment of Colon Laterally Spreading Tumors

Objective To explore the endoscopic diagnosis and treatment of laterally spreading tumor.Methods 27 cases of colon LST were observed through colonoscopy and dye endoscopy,magnifying endoscopy during September 2008 and December 2010 in our hospital.Cases with the tumor diameter 20 mm had endoscopic mucosal resection（EMR）,and cases with the tumor diameter ≥20 mm or V-shaped pit had endoscopic submucosal dissection（ESD）.The lesions were removed after operation and sent for pathological examination.The patients were rechecked using colonoscopy six months later.Results The detection rate was 0.92% for 27 cases of colorectal LST.EMR was carried out in 15 cases with no postoperative bleeding or perforation,and the recheck after six months showed good recovery and no recurrence.Among 12 cases with ESD,2 cases were observed intraoperative bleeding but with successful endoscopic hemostasis.There was no bleeding or no perforation after operation,and the recheck after six months showed good recovery and no recurrence.Conclusion Dye endoscopy and magnifying endoscopy can improve the detection rate of colorectal LST.EMR treatment of colorectal LST is safe and effective,but there are some limitations.ESD can be used as an additional means to treat LST.