Endoscopic submucosal dissection of cecal lesions in proximity to the appendiceal orifice
Endoscopic submucosal dissection of cecal lesions in proximity to the appendiceal orifice
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DOI：
10.1055/s-0042-110396
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发表时间：
2016-09-01
期刊：
影响因子：
9.3
通讯作者：
Azuma, Takeshi
中科院分区：
文献类型：
--
作者：
Jacob, Harold;Toyonaga, Takashi;Azuma, Takeshi
背景与研究目的：内镜下粘膜下剥离术（ESD）用于治疗各种胃肠道病变；然而，盲肠靠近阑尾口仍然是一个具有挑战性的区域。我们回顾了阑尾口附近盲肠ESD的治疗经验，以明确该手术是否是一种安全有效的治疗选择。患者和方法：我们回顾性地回顾了2003年1月至2014年12月在神户大学医院及其附属医院阑尾口约12mm内病变的ESD。病变分为：0型，接近阑尾口但未到达阑尾口；1型，到达阑尾边缘，但不进入孔口；2型，进入孔口，阑尾腔检查可见向正常阑尾粘膜的过渡；3型深入孔口，看不到肿瘤边缘。3型病变不行ESD，除非在ESD之前行阑尾切除术。结果：符合纳入标准的病灶76个，其中0型病灶47个，1型病灶20个，2型病灶6个，3型病灶3个。整体切除72例（94.7%）。中位标本大小为49 mm（范围15-114mm），中位肿瘤大小为35.5mm （10-110mm）。1例患者术后出血，经内镜止血治疗。另一名患者术中穿孔，经夹封治疗后发展为阑尾炎；他接受了紧急回盲手术切除。另一名患者术后阑尾炎，经抗生素治疗痊愈。
Background and study aims: Endoscopic submucosal dissection (ESD) is performed for treatment of various gastrointestinal lesions; however, the cecum in proximity to the appendiceal orifice remains a challenging area. We reviewed our experience with cecal ESD near the appendiceal orifice in order to clarifywhether this procedure is a safe and effective therapeutic option.Patients and methods: We retrospectively reviewed ESD for lesions within approximately 12 mm of the appendiceal orifice at Kobe University Hospital and an affiliated hospital between January 2003 and December 2014. Lesions were classified as: Type 0, proximity to the appendiceal orifice but does not reach it; Type 1, reaches border of the appendix, but does not enter orifice; Type 2, enters orifice, and transition to normal appendiceal mucosa is discernible on inspection of the appendiceal lumen; and Type 3, enters orifice deeply and tumor edge cannot be observed. ESD was not performed for Type 3 lesions unless appendectomy was performed prior to ESD.Results: A total of 76 lesions satisfied the inclusion criteria (47 Type 0 lesions, 20 Type 1, 6 Type 2, and 3 Type 3). En bloc resection was achieved in 72 lesions (94.7 %). Median specimen size was 49 mm (range 15-114mm), and median tumor size was 35.5mm (10-110mm). One patient experienced postoperative bleeding, which was treated by endoscopic hemostasis. Another patient who experienced intraoperative perforation and was treated by clip closure later developed appendicitis; he underwent emergency ileocecal surgical resection. Another patient experienced postoperative appendicitis and recovered with antibiotic treatment.