经肛门内镜显微手术术后复发性直肠病变的内镜黏膜下剥离术的可行性和安全性：病例系列
Feasibility and Safety of Endoscopic Submucosal Dissection for Recurrent Rectal Lesions that after Transanal Endoscopic Microsurgery: A Case Series.
作者信息
Ikezawa Nobuaki, Toyonaga Takashi, Tanaka Shinwa, Nakano Yoshiko, Ishida Tsukasa, Yoshihara Tomoatsu, Uraoka Masanao, Morita Yoshinori, Suzuki Noriko, Haji Amyn, Kodama Yuzo
机构信息
Divison of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.
Department of Endoscopy, Kobe University Hospital, Kobe, Japan,
出版信息
Digestion. 2021;102(3):446-452. doi: 10.1159/000505619. Epub 2020 Feb 5.
OBJECTIVES
Recently, several studies have demonstrated the usefulness of endoscopic submucosal dissection (ESD) for residual or locally recurrent colorectal lesions after endoscopic treatment. However, the feasibility of ESD for recurrent rectal lesions after transanal endoscopic microsurgery (TEM) has not been fully investigated. In this study, we evaluated the feasibility and safety of ESD for recurrent rectal lesions after TEM.
METHODS
The treatment outcomes of 10 lesions in 9 patients, who underwent ESD between January 2006 and March 2018 for recurrent rectal lesions after transanal endoscopic microsurgery, were evaluated.
RESULTS
All lesions were successfully resected en bloc, and the R0 resection rate was 90%. The median size of the resected specimens and lesions (range) was 44 mm (21-70) and 27.5 mm (5-60), respectively. The pathological diagnoses included 4 adenomas and 6 cancerous lesions. The cancerous lesions included 5 cases of mucosal cancer and 1 case of superficial submucosal invasive cancer (depth of submucosal invasion <1,000 μm from the muscularis mucosae). No adverse events occurred. There was no recurrence during the follow-up period.
CONCLUSIONS
ESD for recurrent rectal lesions after TEM by expert's hands appears to be safe and feasible.
目的
最近，多项研究已证明内镜下黏膜剥离术（ESD）对内镜治疗后残留或局部复发的结直肠病变有用。然而，ESD用于经肛门内镜显微手术（TEM）后复发性直肠病变的可行性尚未得到充分研究。在本研究中，我们评估了ESD用于TEM后复发性直肠病变的可行性和安全性。
方法
评估了2006年1月至2018年3月期间9例患者因TEM后复发性直肠病变接受ESD治疗的10个病变的治疗结果。
结果
所有病变均整块成功切除，R0切除率为90%。切除标本和病变的中位大小（范围）分别为44 mm（21 - 70）和27.5 mm（5 - 60）。病理诊断包括4例腺瘤和6例癌性病变。癌性病变包括5例黏膜癌和1例浅表黏膜下浸润癌（黏膜下层浸润深度距黏膜肌层 < 1000 μm）。未发生不良事件。随访期间无复发。
结论
由专家操作的ESD用于TEM后复发性直肠病变似乎是安全可行的。
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