内镜治疗结直肠类癌43例

目的：探讨内镜下结直肠类癌诊断和治疗的安全性和有效性。方法：对黏膜隆起性病变、瘤体直径小于1．5cm、超声内镜检查无肌层浸润,超声或cT检查无转移,疑似结直肠类癌的43例患者,采用内镜下黏膜切除术和内镜黏膜下剥离术治疗。结果：43例患者中术后3d出血2例,迟发性出血1例,均经内镜及药物治疗痊愈;术后平均随访2．5年,无复发及转移。结论：结肠镜是结直肠类癌检查的重要手段,超声内镜是重要的辅助检查;对于直径小于1．5cm、无转移、未侵及肌层的结直肠类癌,行内镜下切除是一种简单、安全有效的方法,术后应定期随访。     

EMR-C及ESD在直肠神经内分泌肿瘤治疗中的应用效果比较

目的比较透明帽辅助内镜下黏膜切除术(EMR-C)及内镜黏膜下剥离术(ESD)治疗直肠神经内分泌肿瘤的效果。方法回顾性分析2012年10月至2017年10月在本院内镜中心就诊并行内镜下切除治疗的直径10 mm的52例直肠神经内分泌肿瘤患者病历资料,根据手术的方式分为EMR-C组(n=29)和ESD组(n=23),比较两组手术时间、完整切除率、术后并发症发生率以及复发情况。结果两组患者年龄、肿物大小及距肛缘距离、完整切除率差异均无统计学意义(均P0.05),EMR-C组手术时间较ESD短(P0.05),ESD组有2例出现术后迟发性出血,两组均没有出现穿孔病例。结论直肠神经内分泌肿瘤患者应用EMR-C与ESD行内镜下治疗,两者的完整切除率相当,但前者手术时间更短,术后并发症更少,可以作为内镜下治疗直肠神经内分泌肿瘤的优先选择。     

十二指肠Brunner腺瘤的内镜治疗

目的探讨十二指肠Brenner腺瘤内镜治疗的价值。方法回顾性分析2006年11月至2011年5月间复旦大学附属中山医院内镜中心行内镜治疗且经病理证实的29例十二指肠Brunner腺瘤患者的临床资料。结果29例患者中男性13例,女性16例,中位年龄为55（29-72）岁。病灶大小（1．7±0．1）cm,其中0．5-1．0cm17例。1．0-2．0cm6例,大于2．0cm6例。无蒂隆起性病灶18例;有蒂病灶11例,其中粗蒂3例,亚蒂2例。内镜治疗中采取圈套电切9例（其中3例外加尼龙绳结扎）,内镜黏膜切除术12例,内镜黏膜下剥离术8例,均获完整切除。术中出血1例约200ml,经多枚金属夹夹闭和尼龙绳圈套后成功止血;术中穿孔1例,予金属夹夹闭：术后第2天发生迟发性出血1例,行内镜止血。全组术后随访2。39（中位数13）个月,生活质量较好,未见任何远期并发症。术后1年复发1例。再次予内镜黏膜下剥离术治疗。结论内镜治疗对于Brunner腺瘤是一种安全、有效的治疗方法。     

早期结直肠癌内镜治疗后追加外科手术必要性的临床分析

背景与目的：以内镜下黏膜切除术（EMR）和内镜下黏膜下层剥离术（ESD）为主的内镜下切除手术已成为目前治疗早期结直肠癌的主要方式。然而,在临床实践中,大多数早期结直肠癌患者,无论内镜治疗后标本病理提示是否为治愈性切除,后续仍追加了外科手术。本研究通过比较早期结直肠癌患者行内镜下治愈性或非治愈性切除治疗后的肿瘤残留情况,分析内镜治疗后追加外科手术的必要性,以期为医生临床决策提供参考。方法：回顾性收集2016年5月—2023年7月中南大学湘雅医院收治的行内镜下治疗手术后追加外科根治性切除术的早期结直肠癌患者病例资料。根据内镜切除后标本送检的病理结果将患者分为治愈性切除组（无肿瘤残留且无脉管神经侵犯）和非治愈性切除组[有肿瘤残留和（或）有脉管神经侵犯],分析两组患者的临床基本资料、病理特征和肿瘤残留情况的差异。结果：在接受内镜下切除治疗后追加外科手术的82例早期结直肠癌患者中,治愈性切除组53例,非治愈性切除组29例。两组患者在性别、年龄、症状、息肉部位、息肉形状、息肉大小、病理类型、浸润深度、追加外科手术间隔时间等基线数据方面均无统计学差异（均P>0.05）。外科手术标本病理结果显示...     

内镜下黏膜切除术治疗结直肠无蒂息肉52例

目前对结直肠息肉的治疗首选内镜下切除,但经内镜切除大的无蒂结直肠息肉比较困难,且容易发生结肠穿孔和出血。内镜黏膜切除术（endoscop-ic mucosal resection ,EMR）是近10年来发展起来的诊治消化道扁平病灶的一项新技术,自2009年1月-2012年5月,我院对52例结肠广基息肉行肠镜下EMR,取得良好疗效,现总结如下。     

双镜联合结肠手术32例

目的探讨双镜联合结肠手术的经验。方法回顾性分析2011年1月~2014年6月32例双镜联合结肠手术的临床资料,包括内镜辅助腹腔镜手术(术中内镜辅助定位结肠病灶,行腹腔镜结肠肠段切除术或腹腔镜结肠癌根治术)25例和腹腔镜辅助内镜手术(术中腹腔镜监视下行内镜手术切除病灶)7例。结果内镜辅助腹腔镜手术25例,其中内镜辅助腹腔镜结肠癌根治术20例,内镜辅助腹腔镜结肠肠段切除术5例。内镜辅助定位成功率100%(25/25),腹腔镜下肠段切除、重建和淋巴结清扫,无中转开腹,无手术并发症。25例随访6~48个月,中位时间30个月,1例死于心肌梗死,24例存活,均未见复发和转移征象。腹腔镜辅助内镜手术7例,其中腹腔镜辅助内镜结肠黏膜下剥离术(ESD)3例,腹腔镜辅助内镜结肠黏膜切除术(EMR)2例,腹腔镜辅助内镜结肠息肉切除术2例,1例ESD术中并发穿孔,行腹腔镜下结肠穿孔修补术。7例随访9~36个月,中位时间24个月,无死亡,未见复发的转移征象。结论双镜联合结肠手术可充分发挥两者优势,提高手术安全性,腹腔镜和内镜团队良好的协作与配合有助于提高双镜手术成功率。     

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。     

内镜黏膜下剥离术治疗结直肠侧向发育型肿瘤的临床疗效及护理体会

目的:分析内镜黏膜下剥离术治疗结直肠侧向发育型肿瘤的临床疗效，总结护理对策。方法:回顾2019年10月至2021年10月郑州市第三人民医院收治的40例结直肠侧向发育型肿瘤患者资料，患者均采用内镜黏膜下剥离术治疗，分析治疗效果及复发率，总结护理对策。结果:本组40例患者均顺利完成手术，其中38例(95.00%)成功完整切除病灶，2例因病灶较大借助圈套器切除。术中出血2例，肠穿孔1例。术后苏醒期躁动1例，迟发性出血1例，肠功能紊乱1例。术后随访1年，复发1例(2.50%)。结论:内镜黏膜下剥离术治疗结直肠侧向发育型肿瘤疗效确切，完整切除率高，复发率低。围手术期做好护理工作，有助于提高手术疗效，促进患者康复。     

大肠类癌的内镜及超声内镜特点

目的 探讨大肠类癌的内镜及超声内镜特点,提高内镜诊疗水平.方法 收集2002-2007年收治的22例大肠类癌患者的临床资料.分析内镜及超声内镜特点及其与浸润深度的关系.结果 早期癌内镜表现为直径1.5cm、黏膜光滑、黏膜内黄白色颗粒样结构;进展期癌内镜表现为直径0.8～3.0cm、黏膜不平、黄白色结节样或表面溃疡.超声内镜特征为:稍低回声,内部散在点状稍高回声,起源于黏膜固有层或黏膜下层不规则卵圆形结构,边缘模糊且不规则.16例黏膜内癌及黏膜下浅层癌行内镜黏膜切除术,其中10例追加氩气刀治疗.随访4～36个月无复发.1例黏膜下深层类癌及5例进展期类癌行外科手术.结论 内镜及超声内镜可诊断大肠类癌及其浸润深度,对早期类癌行内镜治疗可取得较好效果.     

放大式结肠镜检查术对早期结直肠癌浸润深度的判断

由于淋巴结的高转移率,浸润至黏膜下层的早期结直肠癌无法行内镜下黏膜切除术,因而治疗前对病变是否浸润至黏膜下层的准确诊断很重要。Ikehara H、Saito Y、Matsuda T等回顾性研究用放大式结肠镜分析了浸润至黏膜下层的早期结直肠癌的图像特征。379例早期结直肠癌病灶分为表浅型、无蒂型、带蒂型三种亚型,分析了8种与浸润至黏膜下层深度的相关因     

Endosonography during endoscopic mucosal resection to enhance its safety

BACKGROUND: We have performed endoscopic mucosal resection of the esophagus (172 cases), stomach (102 cases), and colon (28 cases) using a transparent plastic cap. Because the lesion-bearing mucosa is suctioned up inside the cap under endoscopic suction, the mucosa should be dissected sufficiently from the proper muscle layer to prevent perforation. METHODS: To avert the risk of perforation, we introduced endosonographic assessment of submucosal dissection (47 cases). In all cases, just keeping the ultrasonic probe on the surface of the mucosa allowed us to evaluate whether the mucosal lesion was lifted up sufficiently from the proper muscle layer after local saline injection. RESULTS: It was possible to confirm that the muscle layer was kept outside the strangulating snare by the same procedure (32 of 37 cases, 86.5%). CONCLUSIONS: We experienced five muscular resections in cases without the ultrasonic probe and no muscular resection with the ultrasonic probe. Thus we recommend endosonographic assessment during endoscopic mucosal resection to enhance its safety.     

Selective fluid cushion in the submucosal layer by water jet: advantage for endoscopic mucosal resection

BACKGROUND/AIM: Numerous new techniques have recently been reported and described for the endoscopic mucosal resection of large superficial lesions of the gastrointestinal tract. We present here for the first time the application of a water jet dissector for mucosa elevation. MATERIALS AND METHODS: In an ex vivo study, the effectiveness of a water jet dissector (Helix Hydro-Jet) placed directly on the stomach walls of 8 pigs was examined to create a mucosal elevation. After having determined optimal pressures, angle of application, and application times, 13 submucosal fluid cushions were produced in different areas of the stomach walls of 8 pigs in vivo, and the sizes of the resulting submucosal cushions were measured. RESULTS: Using pressures between 30 and 70 bar, it was routinely possible to create submucosal fluid cushions in the stomach wall ex vivo as well as in vivo. Histological examination showed a selective edema in the submucosa without damage to the deeper mucosal layers of the gastric wall. CONCLUSIONS: The capacity of a targeted high-pressure water jet to penetrate the mucosa and selectively create a fluid cushion in the submucosa facilitates endoscopic resection of the mucosa. This new method could contribute to ameliorate the endoscopic treatment of mucosal tumors which previously could not be resected endoscopically due to their size, extent, or location.     

Kolorektale Adenome: Pro konventionelle/laparoskopische Resektion

The knowledge that due to the adenoma-cancer sequence polyps will develop sooner or later into invasive cancer demands the complete removal of colorectal polyps. The majority of polyps can be endoscopically removed. The indications for surgical removal of polyps are a previous incomplete endoscopic resection, location not amenable to endoscopic removal and lesions which are macroscopically highly suspicious for malignancy and cannot be detached by submucosal saline injection. If a surgical approach is indicated minimally invasive surgery in the hands of an experienced laparoscopic surgeon is a suitable option. Adenomas suspicious for malignancy in the lower two thirds of the rectum should not be treated by time-consuming endoscopic submucosal dissection (ESD) and can be quickly and safely removed transanally, conventionally or by transanal endoscopic microsurgery (TEM) by a full thickness én bloc resection. This allows the pathologist to determine the depth of invasion and the completeness of resection in terms of the circumferential margin and a definitive radical surgical approach is only necessary in high risk situations.     

内镜黏膜下剥离术治疗食管、胃壁病变46例报告

目的探讨内镜下黏膜剥离术（endoscopic submucosal dissection,ESD）处理食管、胃壁病灶的疗效和安全性。方法 2009年1月～8月胃镜发现的食管、胃壁大小0.5～4.0 cm的黏膜病变25例及大小0.5～3.0 cm的黏膜下病变21例作为入选对象,通过超声内镜和（或）活检病理检查明确病灶大小、位置、性质进行ESD：胃镜及黏膜染色确定病灶,针刀或氩气刀标记病灶;黏膜下注射含亚甲蓝及肾上腺素的生理盐水抬高病变;预切开病变周围黏膜;自病变黏膜下层完整剥离病灶;创面处理。结果黏膜病变25例：均切除病灶;1例穿孔约0.3 cm×0.3 cm,钛夹夹闭后保守治疗愈合;1例术后12 h出血行内镜下紧急止血;随访1～6个月,平均2.5月,术后2个月20例溃疡创面愈合,4例创面大部分愈合,1例术后3个月复发,后转外科手术切除。黏膜下病灶21例：均完整剥离黏膜下肿瘤;1例穿孔0.5 cm×0.5 cm,钛夹夹闭后保守治疗愈合;21例随访1～4个月,平均2个月,1例术后2个月复发再行ESD,其余20例无复发。结论 ESD对于食管、胃壁黏膜病变及黏膜下病变具有整块切除率高、复发率较低、并发症少等优点,值得推广。     

Submucosal glycerol injection-assisted laser surgical treatment of oral lesions

Recently, we modified laser surgery for superficial lesions in the oral cavity by using submucosal glycerol injection. This procedure was based on a technique for endoscopic mucosal resection (EMR) in the gastrointestinal tract. The aim of this study was to evaluate the effectiveness of the modified laser surgery assisted by a submucosal glycerol injection. Eleven superficial oral lesions in ten patients were treated with diode laser (continuous wave mode, 3 W) after a submucosal injection of glycerol solution. Injection of glycerol solution created mucosal expansion, which enabled the procedures to be done without bleeding, overcutting, overcoagulation and unintended irradiation. The surface of the wounds showed little carbonization, resulting in good healing. Submucosal glycerol injection for laser treatment in the oral cavity is a promising technique for treating superficial oral lesions by virtue of less invasion and good results.     

Surgical management of early cancer in Barrett's esophagus

The indication of surgical resection for early cancer in Barrett's esophagus is based on the risk of lymph node extension, which is conditioned by the depth of the lesions. Even if the high resolution endosonography is more sensitive than conventional endosonography for differentiating mucosal from submucosal lesions, it may be lacking for intermediate lesions (m3 and sm1). Macroscopic criteria are useful for identifying high-risk lesions. In contentious cases, endoscopic resection may be considered as a biopsy to determine the further treatment. The endoscopic resection is indicated for mucosal lesions in selected patients. Surgery remains the standard treatment for early cancer in Barrett's esophagus. The transhiatal resection is indicated for high-risk T1a mucosal lesions. The transthoracic resection is indicated for submucosal lesions.     

Double endoscopic intraluminal operation for upper digestive tract diseases: proposal of a novel procedure

BACKGROUND AND OBJECTIVE: Endoscopic treatment of digestive tract diseases, such as early esophageal and gastric neoplasia, has become increasingly popular in recent years as an alternative to surgical procedures in the hope of providing an improved quality of life for these patients. However, one of the limitations of a conventional endoscopic mucosal resection, such as an aspiration mucosectomy and a strip biopsy, has been the size of the lesions to be resected. Both an aspiration mucosectomy and strip biopsy are useful variants for removing flat lesions measuring less than 20 mm in maximal diameter. To overcome such limitations, we devised a double endoscopic intraluminal operation (DEILO), which enables us to resect mucosal lesions by using 2 fine endoscopes and monopolar shears. METHODS: DEILO was performed on patients with esophageal and gastric lesions measuring up to 40 mm in diameter. This novel technique is characterized by the use of 2 endoscopes (one for lifting the lesion and the other for cutting the lesions) inserted into the esophagus or stomach through an overtube. A mucosal resection is then performed by dissecting the mucosal margin with newly developed monopolar shears, thereby separating the mucosa from the submucosa. RESULTS: A total of 25 lesions in the esophagus (8 lesions) and stomach (17 lesions) were resected by DEILO. The sizes of the esophageal lesions ranged from 8 to 40 mm in diameter (mean, 21.1 mm) whereas gastric lesions ranged from 8 to 30 mm (mean, 13.3 mm) in diameter, and histopathologic examinations revealed the resection margin to be clear and without any tumor. No complications or instances of recurrence were observed in this series. CONCLUSIONS: DEILO is considered to be feasible for the mucosal resection of esophageal and gastric lesions measuring more than 10 mm in diameter without submucosal invasion, whereas conventional endoscopic mucosal resection is indicated for such lesions measuring less than 10 mm in size.     

Endoscopic submucosal dissection used for treating early neoplasia of the foregut using a combination of knives

Background Endoscopic submucosal dissection (ESD) has emerged as a novel technique for achieving en bloc resection for early esophageal or gastric carcinoma limited to the mucosa. The authors report their experience with a combination of various devices to treat early neoplasia of the foregut using the ESD technique. Methods In this prospective case series, ESD was performed for early esophageal or gastric carcinoma limited to the mucosa. These lesions were staged by endoscopic ultrasonography before resection. Magnifying endoscopy and chromoendoscopy were used to locate the tumor and define the margin. The resection was accomplished with submucosal dissection using the insulated tip knife, the hook knife, and the triangular tip knife. The resected specimen was examined systematically for the lateral and deep margins. Results From January 2004 to March 2006, ESD was performed to manage 30 cases of early gastric or esophageal carcinoma. For 29 of these patients, R0 resection was successfully achieved. The mean operating time was 84.6 min. One patient experienced reactionary hemorrhage 12 h after resection, which was controlled endoscopically. There was no perforation. Most of the circumferential mucosal incisions were performed using the insulated tip knife (76.6%), whereas submucosal dissection was accomplished with a combination of various knives. One of the specimens showed involvement of the lateral margin, whereas another patient had two areas of new early gastric cancer 6 months after the initial procedure. These patients received salvage laparoscopically assisted gastrectomy. Conclusions Endoscopic submucosal dissection to manage early neoplasia of the foregut can be achieved safely and effectively with a combination of knives. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Colonoscopic Diagnosis and Management of Nonpolypoid Early Colorectal Cancer

Nonpolypoid colorectal neoplasms are grossly classified into three groups: slightly elevated (small flat adenomas), laterally spreading, and depressed. Flat adenomas are not invasive until they are rather large, whereas depressed lesions can invade the submucosa even when they are extremely small. Nonpolypoid lesions are difficult to detect and are often overlooked. Keys to detect them are their slight color change, interruption of the capillary network pattern, slight deformation of the colonic wall, spontaneously bleeding spots, shape change of the lesion with insufflation and deflation of air, and interruption of the innominate grooves. Spraying of indigo carmine dye helps to clarify the lesions. A pit pattern analysis with a zoom colonoscope is useful for the diagnosis and staging of early colorectal cancer. Small flat adenomas are thought to be precursors of protruded polyps and lateral spreading tumors, whereas depressed lesions are thought to grow endophytically and become advanced cancers. Small depressed lesions are treated with an endoscopic mucosal resection (EMR) technique; but when they massively invade the submucosa, surgical resection is indicated. Laterally spreading tumors are not as invasive despite their large size and therefore are good indications for the EMR or piecemeal EMR method. Small flat adenomas need not be treated urgently, as almost none is invasive. Accurate diagnosis with dye-spraying and zoom colonoscopy is vital for deciding the treatment strategy. E-pub: 27 July 2000