大肠粘膜内癌内镜局部治疗的探讨

目的:探讨大肠粘膜内癌内镜下局部治疗的近期和远期效果.方法:对近5年发现的42例大肠粘膜内癌采用活检钳咬除、肛镜下枪式套扎器套扎、圈套高频电切一种或几种方法相互结合进行局部治疗,术后1月～3年用电子结肠镜复查.结果:(1)18例用活检钳全部摘除,3例枪式套扎器套扎,16例圈套高频电切,5例采用多种方法相互结合.(2)有5例同时合并另一进展期癌肿,除1例拒绝手术,1例病期太晚失去手术时机,3例作了扩大根治切除;其余37例中,有7例追加外科手术治疗,切除的肠标本上未发现癌残留.(3)33例(其中未追加手术30例)随访1月～5年,未发现癌复发.(4)随访病例中,14例癌伴多发性腺瘤在术后1～3年新生腺瘤发生率57.1%(8/14);而单发早期癌同期新生腺瘤发生率15.8%(3/19).结论:只要病例选择合适,大肠粘膜内癌经内镜局部切除是可以达到治愈的,而且安全和微创.

Investigation of endoscopic local treatment for colorectal intramucosal carcinoma

Objective:To investigate the effects of endoscopic local treatment for colorectal intramucosal carcinoma.Methods:42 patients with colorectal intramucosal carcinoma were treated with endoscopic local through one or few methods such as biopsy forceps resection,looping ligature and high frequency electric coagulation etc.in past five years.Results:(1)18 cases received biopsy forceps resection,3 cases received looping ligature,16cases received high frequency electric coagulatio resection,5 cases received many kinds of methods.(2)3 cases of 5 cases with advanced carcinoma were operated enlarge radical surgery except 1 cases who refused operation and 1 cases who losted operation opportunity.In the rest 37 cases,7cases were operated surgery,malignant remnants were no founded in theses colon specimens.(3)The following-up 33cases(30 cases without surgery)failed to show recurrent cancer for 1 month to 5 years.(4)In the following-up cases,the incidence of neogenesis adenoma was 57.1% in cancer with pilosity adenoma and was 15.8% in early cancer without adenoma during 1 year to 3 years after operation.Conclusions:It can achieve to healing,security and minimum invasive treatment for endoscopic local resection to colorectal intramucosal carcinoma as long as it is suitable to select case.