内镜黏膜下剥离术治疗大的腔内突出型结直肠肿瘤的临床结局分析  

Clinical Outcome of Endoscopic Submucosal Dissection for Large Protruding Colorectal Tumor

作　　者：史济华 李文彬 张晓宇 王奕然 秦肖芸 王征 许乐 罗庆锋 SHI Jihua;LI Wenbin;ZHANG Xiaoyu;WANG Yiran;QIN Xiaoyun;WANG Zheng;XU Le;LUO Qingfeng(Department of Gastroenterology,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing,100730;Department of Pathology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing,100730)

机构地区：[1]国家老年医学中心,中国医学科学院老年医学研究院,北京医院消化内科,100730 [2]国家老年医学中心,中国医学科学院老年医学研究院,北京医院病理科,100730

出　　处：《胃肠病学》2020年第3期157-161,共5页Chinese Journal of Gastroenterology

摘　　要：背景:内镜黏膜下剥离术(ESD)是侧向发育型结直肠肿瘤的首选治疗方法,但对大的腔内突出型结直肠肿瘤的效果并不太理想。目的:探讨大的腔内突出型结直肠肿瘤的特征和ESD的临床结局。方法:回顾性分析2016年11月—2019年12月在北京医院行ESD治疗的36例直径≥20 mm的腔内突出型结直肠肿瘤患者的临床病理资料,总结患者的临床特征、内镜特征、手术特征和病理特征,并探讨影响ESD的危险因素。结果:36例患者的平均病变直径为(25.44±5.57)mm,病变均位于左半结肠。ESD的整块切除率为75.0%,R0切除率为72.2%,5例(13.9%)患者终止ESD转为外科手术。治愈性切除率为55.6%,非治愈性切除者11例,其中7例追加外科手术,整体外科手术率为33.3%。有肌肉收缩征组整块切除率(0对87.1%,P=0.003)和R0切除率(20.0%对80.6%,P=0.008)均显著低于无肌肉收缩征组。黏膜下层无纤维化(F0)、轻度纤维化(F1)、重度纤维化(F2)的整块切除率、R0切除率、治愈性切除率相比差异均有统计学意义(P<0.001,P=0.000,P=0.010)。结论:直径≥20 mm的腔内突出型结直肠肿瘤的ESD操作技术难度较高,整块切除率、R0切除率较低,治愈性切除率更低。肌肉收缩征、病变黏膜下层严重纤维化可能是影响ESD手术疗效的重要因素。Background:Endoscopic submucosal dissection(ESD)is the first choice for treating laterally spreading colorectal tumor.However,the effect of ESD on large protruding colorectal tumor is not ideal.Aims:To evaluate the features of large protruding colorectal tumor and the clinical outcome of ESD.Methods:The clinical data of 36 patients with protruding colorectal tumor with diameter≥20 mm that undergone ESD from November 2016 to December 2019 at Beijing Hospital were retrospectively analyzed.The clinical,endoscopic,surgical and pathological features were summarized,and the risk factors of ESD were analyzed.Results:The average diameter of 36 lesions was(25.44±5.57)mm.All lesions were located in left hemicolon.The percentage of en bloc resection was 75.0%,and the percentage of R0 resection was 72.2%.ESD procedure was discontinued in 5 patients(13.9%)and were converted to surgery.The rate of curative resection was 55.6%.Non-curative resection was found in 11 patients,and of them 7 patients accepted surgery later.The overall rate of surgery was 33.3%.The en bloc resection rate(0 vs.87.1%,P=0.003)and R0 resection rate(20.0%vs.80.6%,P=0.008)were significantly decreased in muscle-retracting sign group than in non-muscle-retracting sign group.There were significant differences in en bloc resection rate,R0 resection rate and curative resection rate among the non-submucosal fibrosis(F0),mild fibrosis(F1)and severe fibrosis(F2)groups(P<0.001,P=0.000,P=0.010).Conclusions:The ESD procedure of large protruding colorectal tumors≥20 mm is technically difficult.The rates of the en bloc resection and R0 resection are low,and the curative resection rate is even more lower.Muscle-retracting sign,severe submucosal fibrosis are the important factors that affecting the outcome of ESD operation.

关 键 词：腔内突出型肿瘤 结直肠肿瘤 内镜黏膜下剥离术 治疗 

分 类 号：R73[医药卫生—肿瘤]