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中华胃肠内镜电子杂志 ›› 2023, Vol. 10 ›› Issue (03) : 213 -215. doi: 10.3877/cma.j.issn.2095-7157.2023.03.015

病例报告

大肠无蒂锯齿状病变内镜诊断、ESD治疗及术后电凝综合征1例
宋秀江(), 李媛媛, 安晓静   
  1. 100091 北京,中国中医科学院西苑医院脾胃病科(消化科)
    100091 北京,中国中医科学院西苑医院病理科
  • 收稿日期:2023-03-30 出版日期:2023-08-15
  • 通信作者: 宋秀江

One case of sessile serrated lesion in the colon: Endoscopic iagnosis, submucosal dissection(ESD) treatment,and postoperative electrocoagulation syndrome

Xiujiang Song(), Yuanyuan Li, Xiaojing An   

  • Received:2023-03-30 Published:2023-08-15
  • Corresponding author: Xiujiang Song
引用本文:

宋秀江, 李媛媛, 安晓静. 大肠无蒂锯齿状病变内镜诊断、ESD治疗及术后电凝综合征1例[J]. 中华胃肠内镜电子杂志, 2023, 10(03): 213-215.

Xiujiang Song, Yuanyuan Li, Xiaojing An. One case of sessile serrated lesion in the colon: Endoscopic iagnosis, submucosal dissection(ESD) treatment,and postoperative electrocoagulation syndrome[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2023, 10(03): 213-215.

大肠无蒂锯齿状病变(sessile serrated lesion, SSL)是一种外表类似于增生性息肉(hyperplastic polyp, HP)但具有独特组织构造特征的大肠息肉。SSL和传统锯齿状腺瘤(traditional serrated adenoma, TSA)可通过"锯齿状肿瘤途径"导致结直肠癌,占散发性癌发生率达15%~30%[1],目前已被公认为除腺瘤-癌、炎症-异型增生-癌变、de novo癌途径之外新的结直肠癌癌变途径。因此,内镜检查早期发现和切除SSL对于预防结直肠癌的发生非常重要。中国中医科学院西苑医院消化科1例内镜黏膜下剥离术(endoscopic submucosal dissection, ESD)切除SSL的内镜诊断具有典型性,因处盲肠,ESD治疗难度较大,且切除后出现电凝综合征的并发症,经过适当处理后很快恢复,能全面反映SSL内镜诊断、ESD治疗及并发症处理的全过程,故报告如下。

图1 术中内镜诊断注:A:白光所见;B:NBI放大内镜所见;C:靛胭脂染色所见;D:染色后放大内镜所见
图2 ESD过程注:A:黏膜下注射;B:病变外侧切开;C:黏膜下剥离;D:病变里侧切开,做好终点;E:隧道贯通;F:完整切除病变;G:金属夹缝合创面;H:标本
图3 术后病理组织学所见注:A、B:(HE×100)腺管底部有靴状的倒T字状扩张,可见腺管扭曲和蛇形分支,诊断为SSA/P
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