内镜黏膜下剥离术治疗早期结直肠癌及癌前病变临床效果观察  

Clinical observation of endoscopic submucosal dissection in the treatment of early colorectal carcinoma and precancerous lesions

作　　者：高岩[1] 蓝宇[1] 贾纯增[1] GAO Yan;LAN Yu;JIA Chun-zeng(Department of Digestive Internal Medicine,Beijing Jishuitan Hospital,Beijing 100096,China)

机构地区：[1]北京积水潭医院消化内科,北京100096

出　　处：《临床军医杂志》2020年第6期668-671,675,共5页Clinical Journal of Medical Officers

摘　　要：目的探讨内镜黏膜下剥离术治疗早期结直肠癌及癌前病变的有效性和安全性。方法回顾性分析北京积水潭医院自2015年1月至2018年1月收治的因早期结直肠癌或癌前病变行结肠内镜黏膜下剥离术的304例患者的临床资料,包括人口学特征、病变特征、手术过程、手术结局、并发症、病理学结果等。结果304例患者共行内镜黏膜下剥离术317例。整块切除278例(87.7%),完全切除263例(83.0%),治愈性切除252例(79.5%);术中穿孔14例(4.4%),迟发穿孔2例(0.6%),迟发出血6例(1.9%),电凝综合征12例(3.8%),术后发热22例(6.9%)。317例中,隆起型病变77例(隆起组),侧向发育肿瘤型病变240例(侧向发育肿瘤组)。两组患者整块切除、完全切除、治愈性切除比例及手术时间、住院时间比较,差异均无统计学意义(P>0.05)。两组患者术中穿孔、迟发穿孔、迟发出血、电凝综合征、术后发热等并发症发生情况比较,差异也无统计学意义(P>0.05)。非治愈性切除的65例中,22例接受补救外科手术;43例选择随访观察,其中,失访8例,其余35例平均随访时间为12.8个月,2例发现结肠癌远处复发,其余未见局部残留或复发。治愈性切除252例,平均随访时间为18.4个月,随访期间未见局部残留或复发。结论内镜黏膜下剥离术在治疗早期结直肠癌及癌前病变方面具有良好的有效性及相对较高的安全性。Objective To evaluate the efficacy and safety of endoscopic submucosal dissection in early colorectal carcinoma and precancerous lesions.Methods A retrospective study was performed on 304 cases of patients with early colorectal carcinoma and/or precancerous lesions who were admitted and underwent endoscopic submucosal dissection from January 2015 to January 2018.The clinical data including demographic characteristics,pathological features,surgical procedures,surgical outcomes,complications and pathological results were analyzed.Results A total of 304 patients underwent endoscopic submucosal dissection in 317 cases.Total resection was performed in 278 patients(87.7%),total resection in 263 patients(83.0%),and curative resection in 252 patients(79.5%).Intraoperative perforation was found in 14 cases(4.4%),delayed perforation in 2 cases(0.6%),delayed bleeding in 6 cases(1.9%),electrocoagulation syndrome in 12 cases(3.8%)and postoperative fever in 22 cases(6.9%).Of the 317 patients,77 had raised lesions(the raised group)and 240 had laterally developed tumor lesions(the laterally developed tumor group).There was no significant difference between the two groups in the proportion of total resection,total resection,curative resection,operation time and hospital stay(P>0.05).There was no statistically significant difference between the two groups in the occurrence of intraoperative perforation,delayed perforation,delayed bleeding,electrocoagulation syndrome,postoperative fever and other complications(P>0.05).Of the 65 cases of non-curative resection,22 underwent remedial surgery.Forty-three patients were selected for follow-up observation,of which 8 were lost to follow-up.The mean follow-up time of 35 cases was 12.8 months,2 cases had distant recurrence of colon cancer,and the rest had no local residual or recurrence.The mean follow-up time of 252 patients with curative resection was 18.4 months,during which no local residual or recurrence was observed.Conclusion Endoscopic submucosal dissection is effective and relativel

关 键 词：内镜黏膜下剥离术 结直肠癌 癌前病变 

分 类 号：R735[医药卫生—肿瘤]