探讨采用内镜黏膜下剥离术(ESD)治疗结直肠侧向发育型息肉的应用价值。

回顾性分析2018年1月至2019年12月经内蒙古消化病研究所内镜中心行肠镜检查发现的45例结直肠侧向发育型息肉患者，应用IT刀、Hook刀行ESD治疗。将ESD成功率、剥离病变大小、手术时间、手术并发症及复发率等纳入观察范围。

45例结直肠病变接受ESD，其中，2例病变黏膜下注射后病变托举差，术中剥离困难且容易出血转外科手术。术后病理证实，3例癌变且基底仍有肿瘤残留，行外科手术扩大切除。ESD成功率88.9%(40/45)。病变直径为1.5～6.3 cm，平均3.6 cm；ESD手术时间为31～125 min，平均67 min。3例术后有便血，其中1例保守治疗失败，内镜下成功电凝止血，ESD术后出血发生率7%(3/43)。4例在ESD治疗中有小穿孔，应用软组织夹成功缝合穿孔，未转开腹手术，ESD穿孔发生率为9.3%(4/43)。术后40例患者均随访，创面基本愈合，无病变残留和复发。

ESD治疗结直肠侧向发育型息肉疗效可靠，能完整切除较大的病变，提供完整的病理学资料且复发率低。出血和穿孔是其主要的短期并发症。

To evalute the practical value of endoscopic submucosal dissection (ESD) for treatment of lateral colorectal polyps.

Retrospective analysis was performed on 45 cases of lateral colorectal polyps found by colonoscopy in endoscopy center of Inner Mongolia institute of digestive diseases from January 2018 to December 2019. IT knife and HOOK knife were applied in the ESD treatment. ESD success rate, lesion size, operation time, complications and recurrence rate were evaluated.

45 cases with colorectal lesions were enrolled in this study. ESD was given up in 2 cases of lateral colorectal polyps with non-lifting sign.3 cases had tumor residue in the wound after ESD and one receieved an additional operation after failed conservative therapy.The success rate of ESD was 88.9% (40/45). The diameters of the lesions ranged from 1.5 to 6.3 cm with mean size of 3.6 cm.The mean ESD procedure time was 67 minutes (ranged from 31 to 125 minutes).3 cases had hematochezia after ESD and one of whom failed after conservative treatment and bleeding was controlled by electrocoagulation under endoscope. The bleeding rate was 7.0%(3/43). Perforation occurred in 4 cases during the dissection of the lesions, which was typically closed with metallic endoclips without surgical treatment. The perforation rate of ESD was 9.3%(4/43). All the 40 patients were followed up after ESD, with confirmed healing of the artificial ulcer with no residue or recurrence.

ESD for lateral colorectal polyps is of reliable curative effect as it can not only wholly remove the lesions but also provide pathological proof for reference with low recurrence rate. Bleeding and perforation are the main short-term complications.