内镜反转黏膜切除术治疗大型超低位直肠侧向发育型肿瘤18例临床研究刘思徳，张亚历，周丹，万田谟，陈村龙，潘徳寿，张振书，智发朝，周殿元，姜泊（南方医科大学附属南方医院消化内科，广州510515）摘要：目的研究内镜反转黏膜切除术（retroflexendoscopicmucosalResection,REMR）对大型超低位直肠侧向发育型肿瘤的治疗效果，并对其适应证、并发证和操作方法等问题进行讨论。方法选择直径大于3.0cm，肿瘤下缘距丿IT缘齿状线小于2cm,有内镜治疗适应证的18例超低位直肠侧向发育型肿痫，应用内镜反转黏膜切除术（REMR）进行肿瘤切除,术后3〜2彳个月行内镜随访确认有无残留,以评价切除效果，记录术中及术后发生的并发证及处理情况，并分析切除标本的病理组织学结果。结果接受REMR治疗的18例,平均手术时间为16.4min,其中16例经首次或再次REMR治疗病变完整清除，肛门功能完好，保肛治愈率为88.8%,术后病理报浸润癌（SH癌）再追加外科根治手术者1例（5.6%）；因病变残留转外科行经腹会阴联合切除手术者1例（5.6%）。并发症：本组18例术中平均出血20ml,最大lllJfll160ml,均无需输血治疗，无穿孔发生，无术后并发症。结论内镜反转黏膜切除术是一种安全微创的内镜治疗手段,对大多数接近齿状线的超低位直肠侧向发育型肿瘤能达到完全切除效果,并可完美保全肛门功能。关键词：内镜反转黏膜切除术：低位直肠：侧向发育犁肿瘤中图法分类号：文献标识码：AClinicStudyonRetroflexEndoscopicMucosalResectionforTreatmentofsuper-LowRectalLaterallySpreadingTumorLiuSi-de,ZhangYa-li,ZhouDan,WanTian-mo,ChenCun-long,PanDe-shou,ZhangZhen-shu,ZhiFa-chao,ZhouDian-yuan.JiangBo（Dept,ofGastroenterology;NanfangHospital,TheNanfangMedicalUniversity,Guangzhou.510515,China）Abstract：Objective:Toinvestigstethecurativeeffectonretroflexendoscopicmucosalresection（REMR）forlargesizespuerlowrectailateralspreadingtumorsandtodiscusstheapplications,coinplications,dndtechniquesofthisprocedurc.Methods:Thepatientswereselectedasfollow:thetumorsizemorethan3・0centimetersandthetumorlocatedlessthan2・0centimetersforanus・Atotalof17patientswereincludedinthisstudy.REMRwereperformedbymeansofenblocorpiecemealsnarecutmethod・Thefollow-upperiodwas3-24monthstoevaluatethecurativeeffect・Theratesofcompliedtionsandfollowingtreatmentswererecorded・Allresectedspecimenswereretrievedforpathologicalstudy•Results:18patientsacceptedREMRprocedures,and16patientJstumorwerecompletelyremovedbyonceormu11ip1eREMRprocedures.Al1ofthese16patientswereretainedperfectanus・Thecurativeratewas88・8%.Therewerenoremnantsorrecurrenceoftumorsduringthefollow-up.Onepatientacceptedmile"soperationbecausethepathologysuggestioninvasivecancerafterREMRandanotherpatientacceptedmile,soperationduetotumorresudialafterREMR・Thecomplicationsasfollow:theaveragebleedingis20mlandthemaxiumbleedingwere160ml.Nopatientsneedtobloodtransfusion.Noperforationoccuered.NoothercompelicationsoccurredafterREMRprocudures・Conclusion:REMRisasafeandminimallyinvasivetherapyforthetreatmentofsuperlowrectaltumor・Itctmcompletelyresectthemajorityoflowrectalbenigntumorsandcanperfectretainedtmusfunctions・Keywords:retroflexondoscopicmucosalresection:superlowrectal:laterallyspreadingtumor（问题1:核对作者简介部分。）作者简介:刘思德,男,博士,主任医师,教授,主要从事早期大肠癌的内镜诊治及生物人工肝的生物材料研制。电话:（020）61641537.13902212459,E-maiI:Iiuside©163.com通信作者:姜泊,电话：（020）61641541,E-mail：dijiang@163.com收稿日期:2009-03-30；修回日期:低位胃肠的大型平坦型肿瘤，即使肿瘤为良性，但因内镜处理困难，往往归属于外科适应证，如果行常规的经腹会阴联合切除术（M订e's手术），虽可根治肿瘤，但将失去肛门...