目的 评价内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗直肠扁平癌前期疾病和黏膜内癌的临床价值.方法 收集2006年11月至2011年3月复旦大学附属中山医院内镜中心83例行直肠ESD的术前活检资料(术前活检病理均证实重度不典型增生或黏膜内癌),评价ESD手术的安全性和疗效.结果 83例中低位直肠(距肛缘7cm以下)病变52例,中位直肠(距肛缘7～12cm)18倒,高住直肠(距肛缘13-18cm)13例;痛灶平均直径(2.29±3.11)cm.所有病人均顺利完成内镜切除手术,手术时间(15～129)min,出血量(5～400)mL.病灶整块切除率85.5%(71/83).术中穿孔12例(14.5%),术中出血11例(13.3%),术后迟发性出血6例(7.2%),均通过保守治疗好转.83例均接受随访,随访时间3～31(15±6)个月,无复发病例.结论 ESD治疗较大的、扁平的直肠癌前期疾病和黏膜内癌具有较好的疗效和安全性,值得推广应用.%Objective To assess the value of endoscopic submucosal dissection treating flat rectal precancer or cancer in-situ lesions. Methods Eighty-three patients with flat rectal precancer or cancer in-situ leisions were treated with ESD from November 2006 to March 2011 in the Endoscopic center, Zhongshan Hospital of Fudan University.Complications and relapse rate were analyzed. Results Fifty-two patients were located in lower rectum (lower than 7cm from anal), 18 in the middle rectum (7-12cm from anal) and 13 in higher rectum (13-18cm from anal). All the patients received ESD successfully. The median operating time was 42( 15-129)min and median blood loss was 50(5-400)mL.Mean diameter of the lesions was 2.29±3.11 (1.6-8.5) cm. En-bloc resection rate was 85.5％ (71/83). The main complications included perforation in 12 (14.5％) patients, bleeding during the operation in 11 (13.3％) patients and delayed bleeding in 6(7.2％) patients. All 83 patients were followed up with the mean follow-up time of 3-31 (15±6) months and no recurrence occurred. Conclusion ESD is an effective, safe, minimal invasive method to deal with flat rectal precancer or cancer in-situ leisions.
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