内镜粘膜切除和内镜亚粘膜剖析
1Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio.
Clinics in colon and rectal surgery
|August 12, 2024
概括
与传统方法相比,先进的内镜切除技术,如内镜膜下切割 (ESD),为结直肠多瘤提供更高的块切除率,减少了手术需求. 对于较大的息肉和早期癌症,ESD特别有效.
科学领域:
- 胃肠病学 胃肠病学
- 内視鏡外科手術 內視鏡外科手術
- 在瘤学瘤学.
背景情况:
- 传统的多角切除术适用于有限比例的结直肠多.
- 先进的内镜切除技术比传统方法提供了更好的结果.
- 这些先进的技术可以帮助患者避免手术并发症.
研究的目的:
- 为了比较先进的内镜切除技术的疗效,特别是内镜粘膜切除 (EMR) 和内镜亚粘膜切除 (ESD).
- 评估结块切除率,复发率和ESD在治疗结肠直肠多和早期癌症中的适应性.
主要方法:
- 在下注射和升高后,EMR涉及陷切除.
- 对于更大或更复杂的病变,ESD包括标记,下注射,切口和剖析.
- 诸如出血和穿孔等并发症可以通过内镜剪切和凝血来控制.
主要成果:
- 在EMR的整体切割率从44.5%到63%不等,而ESD达到87.9%到96%.
- 与ESD (0.9%2%) 相比,EMR的复发率更高 (7.4%17%).
- 在特定条件下,ESD对内癌和有限的下侵袭 (<1000微米) 的癌症有效.
结论:
- 建议ESD用于多体>20mm和选择的早期结直肠癌.
- 与EMR相比,ESD显示出优异的块切除和较低的复发率.
- 针对特定的侵入性癌症,ESD是手术的可行替代方案,其成功率高,利率为负.
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