内镜黏膜下剥离术治疗大肠侧向发育型肿瘤的临床疗效观察

目的：探讨内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）在切除大肠侧向发育型肿瘤（lateral spreading tumor，LST）中的价值和疗效。方法：回顾性分析2012年1月-2013年8月间我科采用ESD治疗的21例LST患者，分析整块病灶切除率、切除病灶直径、手术操作时间、术中术后并发症、复发率及治愈率。结果：21例行ESD治疗的LST，ESD手术完整切除率为90.48%（19/21）；切除病灶直径1.1-10 cm，平均（3.7±3.1） cm；从黏膜下注射至完整剥离结束时间10-115 min，平均（75±46.5） min；2例出现术中穿孔，1例出现术后迟发性出血，经保守治疗后均好转。其中癌变2例，余均为良性病变。随访3-12个月无病变残留或复发。结论：ESD治疗LST的整切率高，操作时间短，复发率低。

The clinical effect of endoscopic submucosal dissection treating colorectal lateral spreading tumor

Objective：To explore the clinical effect of endoscopic submucosal dissection treating colorectal lateral spreading tumor. Methods：21 cases of lateral spreading tumor patients were retrospectively collected hospitalized from Jan. 2012 to Aug. 2013 to analyze the rate of whole lesion dessection, the diameter of dessected lesion, the operation time, the complications, the recurrence rate and the healing rate. Results： （1） The rate of whole lesion dessection of colorectal lateral spreading tumor treated with endoscopic submucosal dissection was 90.48%（19/21）;the diameter of the lesion was 1.1-10 cm, average（3.7±3.1） cm;the operation time was 10-115 min, average（75±46.5） min;the rate of perforation was 9.5%（2/21）, delayed bleeding was 4.8%（1/21）. 19 cases were pathologically negative on sliced border and neoplasm infiltration were found in two cases, one of which treated with surgical operation, and the other treated with radiation. All of the 19 cases had been follow-up for 3 to 12 months and none of them had residual lesion or recurrence. Conclusion： The endoscopic submucosal dissection treating col-orectal lateral spreading tumor has high rate of whole lesion dissection, short of operation time and low rate of recurrence.