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结直肠癌是全球高发的恶性肿瘤。其传统治疗面临器官功能丧失与生活质量下降等挑战。内镜黏膜下剥离术（endoscopic submucosal dissection, ESD）作为一种根治性微创治疗手段，适用于早期结直肠癌，通过黏膜下层精准剥离实现病变整块切除，显著降低局部复发率，已逐步替代根治性手术成为关键治疗选择。本文系统综述了ESD在结直肠癌领域的最新进展，涵盖其适应证与禁忌证的演变、临床应用疗效与并发症风险、在溃疡性结肠炎相关肿瘤性病变治疗中的效果和器械创新（特别是机器人辅助系统）对技术革新的推动作用。总体而言，ESD正推动结直肠癌治疗模式向保留器官功能的微创根治性治疗转变，其技术标准化与持续进步是优化临床预后的关键。
Abstract：Colorectal cancer（CRC） represents one of the most prevalent malignancies worldwide. Conventional therapeutic approaches are frequently associated with compromised organ function and reduced quality of life. Endoscopic submucosal dissection（ESD）, a curative minimally invasive technique indicated for early-stage CRC, achieves en bloc resection of neoplastic lesions through precise submucosal dissection, thereby significantly diminishing local recurrence rates. Consequently, ESD has progressively supplanted radical surgery as a cornerstone therapeutic strategy. This review systematically synthesizes recent advancements in ESD for CRC management, encompassing the evolution of its indications and contraindications, clinical efficacy and complication profiles, therapeutic outcomes in ulcerative colitis-associated neoplasia, and the instrumental innovations（particularly robotic-assisted systems） propelling technical refinement. Collectively, ESD is reshaping the CRC treatment paradigm toward organ-preserving, minimally invasive, and curative interventions, wherein standardization and sustained technical progress remain pivotal for optimizing clinical outcomes.
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基本信息:
DOI：10.13267/j.cnki.syzlzz.2025.077
引用信息:
[1]黄小玉,王君澍,苗格,等.内镜黏膜下剥离术治疗结直肠癌的研究进展[J],2025,40(06):539-545.DOI:10.13267/j.cnki.syzlzz.2025.077.
基金信息:
国家自然科学基金面上项目(82173256);陕西省重点研发计划(2024SF-GJHX-04);消化系肿瘤整合防治全国重点实验室课题(CBSKL2022ZZ55)