CAJ | 학술논문

目的评价内镜黏膜下剥离术(ESD)在治疗巨大早期低位直肠癌及其癌前病变中的价值.方法对24例病变位于低位直肠且直径超过5 cm的早期直肠癌及其癌前病变患者的临床资料进行回顾性总结,分析其临床病理特征、治愈性切除率、并发症及随访结果.结果病灶最长径在5～7 cm,平均为5.54 cm；操作时间在45～180 min,中位时间为85 min.整块切除率为91.7％(22/24),治愈性切除率为83.3％ (20/24),穿孔发生率为8.3％ (2/24),迟发性出血率为12.5％(3/24).术后随访16 ～ 47个月,无局部复发.结论 ESD治疗巨大早期低位直肠癌及其癌前病变是安全和可行的,可完整切除病灶,在达到治愈性切除及大块活检的目的同时保留了肛门的功能.
목적 평개내경점막하박리술(ESD)재치료거대조기저위직장암급기암전병변중적개치.방법 대24례병변위우저위직장차직경초과5 cm적조기직장암급기암전병변환자적림상자료진행회고성총결,분석기림상병리특정、치유성절제솔、병발증급수방결과.결과 병조최장경재5～7 cm,평균위5.54 cm；조작시간재45～180 min,중위시간위85 min.정괴절제솔위91.7％(22/24),치유성절제솔위83.3％ (20/24),천공발생솔위8.3％ (2/24),지발성출혈솔위12.5％(3/24).술후수방16 ～ 47개월,무국부복발.결론 ESD치료거대조기저위직장암급기암전병변시안전화가행적,가완정절제병조,재체도치유성절제급대괴활검적목적동시보류료항문적공능.
Objective To evaluate the therapeutic value of endoscopic submucosal dissection (ESD) for early large low rectal carcinomas and its precancerous lesions.Methods The clinical data,pathology,complications and follow-up results of 24 cases of early large low rectal carcinomas and precancer ous lesion,which were larger than 5cm in diameter and treated by ESD,were retrospectively analyzed.Results The mean diameter of the lesions was 5.54 (5-7) cm,and the mean procedure time was 85 (45-180)min.The en bloc resection rate was 91.7％ (22/24),and histologically en bloc resection rate was 83.3％ (20/24).With regard to complication,3 cases of postoperative hemorrhage (12.5％) and 2 cases of perforation (8.3％) were recorded,and no local recurrence or metastasis was observed duringthe follow-up of 16-47 months.Conclusion ESD is effective for the treatment of large nonpedunculated low rectal tumors.The ESD procedure facilitates a more precise pathologic diagnosis and reduces recurrence through en bloc resection,which also retains the function of the anus.