结直肠癌患者内镜下黏膜剥离术前行超声内镜联合放大内镜检查的价值  

Endoscopic ultrasonography combined with optical magnifying endoscopy before endoscopic submucosal dissection for colorectal cancer

作　　者：李明东[1] 向睿[1] 唐丙喜[1] 陶涛[1] 张启杰[1] 朱萧[2] LI Ming-dong;XIANG Rui;TANG Bing-xi;TAO Tao;ZHANG Qi-jie;ZHU Xiao(Department of Gastroenterology,Zibo Central Hospital,Zibo,Shandong 255000,China;Guangdong Province Key Laboratory of Medical Molecular Diagnosis,Guangdong Medical College,Guangzhou,Guangdong 523000,China)

机构地区：[1]淄博市中心医院消化内科,山东淄博255000 [2]广东医学院医学分子诊断中心实验室,广东广州523000

出　　处：《中华实用诊断与治疗杂志》2021年第3期294-297,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(81541153);淄博市重点研发计划(公益类专项)(2019gy010128)。

摘　　要：目的分析拟行内镜下黏膜剥离术(endoscopic submucosal dissection,ESD)治疗的早期结直肠癌患者的临床资料,探讨ESD治疗前行超声内镜联合放大内镜检查的价值。方法169例拟行ESD治疗的早期结直肠癌患者,其中72例治疗前行超声内镜联合放大内镜检查者为观察组,另97例直接行ESD者为对照组。比较2组年龄、男性比率、肿瘤大小、肿瘤位置、组织病理特征;比较2组ESD并发症发生情况;比较2组ESD治疗后非治愈性切除发生率、治愈性切除率、再次ESD或外科治疗率。结果2组年龄、男性比率、高级别瘤变比率、高分化腺癌比率、中分化腺癌比率、直肠位置肿瘤比率及肿瘤大小比较差异均无统计学意义(P>0.05)。观察组4例经超声内镜联合放大内镜检查不符合ESD治疗指征,转外科手术治疗;余68例行ESD治疗,术中无中转外科手术病例,2例术中穿孔者于内镜下闭合成功,2例术后延迟出血者于内镜下止血成功,术中无急性大量出血发生;ESD术后3例发生非治愈性切除,其中1例行外科手术治疗,2例再次行ESD治疗。对照组ESD术中2例发生较大穿孔且内镜下不可闭合转外科手术,2例因粘连严重且病变基底部广基抬举阴性转外科手术,术中无急性大量出血发生;ESD术后10例发生非治愈性切除,其中8例行外科手术,2例再次行ESD治疗。观察组ESD非治愈性切除率(4.4%)、再次ESD或外科治疗率(4.4%)均低于对照组(10.3%、14.4%)(P<0.05),观察组ESD治愈性切除率(95.6%)与对照组(85.6%)比较差异无统计学意义(P>0.05)。结论超声内镜联合放大内镜检查可有效评估早期结直肠患者ESD治疗指征,降低非治愈性切除率,减少术后再次ESD或外科手术概率。Objective To analyze the clinical data of early colorectal cancer patients scheduled for endoscopic submucosal dissection(ESD),and to investigate the clinical value of endoscopic ultrasonography(EUS)combined with optical magnifying endoscopy before ESD procedure in patients with early colorectal cancer.Methods In 169patients scheduled for ESD for early colorectal cancer,72patients received EUS combined with optical magnifying endoscopy(observation group)and 97received ESD procedure(control group).The patient age,male ratio,volume of tumor,location of tumor,and pathological result of the tumor were compared between two groups.The complication incidence of ESD,the non-curative resection rate,curative resection rate,and second ESD procedure or surgery rate were compared between two groups.Results There were no significant differences in the age,male ratio,incidences of high-grade neoplasia,highly differentiated adenocarcinoma,moderately differentiated adenocarcinoma and rectal cancer,as well as the volume of tumor between two groups(P>0.05).In observation group,4patients converted to surgery due to non-conform to surgical indications after evaluation by EUS combined with magnifying endoscopy before ESD;the other 68patients had ESD procedure without conversion to open surgery,during which intraoperative perforation occurred in 2patients and was successfully closed under endoscope,delayed postoperative hemorrhage occurred in 2and was stopped under endoscope,and no acute hemorrhage occurred during operation;three patients with non-curative resection after ESD were performed operation again,in which 1patient received surgery and 2received ESD again.In control group,4patients converted to surgery during ESD procedure due to too large perforation in 2patients,and due to too severe adhesion and negative lift test of the lesion basal sessile in 2patients;10patients with non-curative resection after ESD were performed operation again,in which 8patients received surgery and 2received ESD again.The non-curative resection rate,

关 键 词：早期结直肠癌 超声内镜 放大内镜 内镜黏膜下剥离术 

分 类 号：R735.34[医药卫生—肿瘤]