内镜黏膜下剥离术治疗结直肠肿瘤的回顾性研究  

A retrospective study of endoscopic submucosal dissection for colorectal tumors

作　　者：刘青青[1] 史志猛[1] 于红刚[1] 吴露[1] 王政强[1] 

机构地区：[1]武汉大学人民医院消化内科,武汉430060

出　　处：《中华消化内镜杂志》2017年第12期857-860,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的评价内镜黏膜下剥离术（ESD）治疗结直肠肿瘤的临床价值，并探讨手术时间的影响因素。方法2014年1月至2015年9月间，将武汉大学人民医院消化内科行ESD治疗的74例结直肠肿瘤病例纳入回顾性分析，总结ESD的临床疗效、并发症发生情况以及随访结果，并对可能影响手术时间的因素进行统计学分析。结果ESD的一次性整块切除率为97．30％（72／74），组织学治愈性切除率为89．19％（66／74）。8例组织学非治愈性切除者中，2例病变浸润较深（SM2）追加开腹手术，其余6例病理结果提示腺瘤予严密随访。74例无一例发生术中急性出血，4例（5．41％，4／74）术后延迟出血，经内镜下止血成功，4例（5．41％，4／74）术中穿孔于内镜下成功闭合，术后无一例出现气腹并发症。随访15～35个月，无复发及异时病灶发生。多元线性回归分析发现肿瘤大小是影响ESD手术时间的主要因素（P=0．000）。结论ESD作为一种微创治疗方法，治疗结直肠肿瘤安全有效，手术时间的长短主要取决于肿瘤大小。Objective To investigate the clinical efficacy of endoscopic submucosal dissection （ESD） for the treatment of colorectal tumors, and to analyze risk factors affecting operation time. Methods A retrospective study was conducted using data of 74 cases with colorectal tumor, who underwent ESD in Department of Gastroenterology of Wuhan University Renmin Hospital from January 2014 to September 2015. The clinical efficacy of ESD, occurrence of complications and follow-up results were summarized, and the risk factors of operation time were analyzed. Results The rate of ESD en bloc resection and histological complete resection was 97.30% （72/74） and 89. 19% （66/74）, respectively. Among the 8 cases of histological non-curative resection, 2 cases received appended surgical procedures because of deep invasion of tumor （SM2） , 6 cases were given close follow-up according to the pathological result of adenomas. Among the 74 cases, no acute hemorrhage or pneumoperitoneum occurred. Four cases （5.41%, 4/74） had postoperative delayed bleeding, and were successfully treated by endoscopic hemostasis. Four cases （5.41%, 4/74） had intraoperative perforation, and were successfully treated by endoscope. No recurrence or abnormal lesions occurred during the follow-up of 15-35 months. Multivariate linear regression analysis showed that tumor size was a main risk factor for ESD operation time （P=0. 000）. Conclusion ESD, as a minimally invasive treatment, is safe and effective for the treatment of colorectal tumors, and the tumor size is a main risk factor of ESD operation time.

关 键 词：结直肠肿瘤 内镜治疗 内镜黏膜下剥离术 并发症 手术时间 

分 类 号：R735.34[医药卫生—肿瘤]