内镜黏膜下剥离术治疗≥20 mm结直肠肿瘤的临床结局分析  

Clinical outcomes of endoscopic submucosal dissection for large colorectal tumors

作　　者：史济华[1] 李文彬 张晓宇 王奕然 王征[2] 许乐[1] 罗庆锋[1] Shi Jihua;Li Wenbin;Zhang Xiaoyu;Wang Yiran;Wang Zheng;Xu Le;Luo Qingfeng(Department of Gastroenterology,Beijing Hospital,Beijing 100730,China;Department of Pathology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

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

出　　处：《中华消化内镜杂志》2021年第12期991-996,共6页Chinese Journal of Digestive Endoscopy

基　　金：中央高校基本科研业务费专项资金(3332019123)。

摘　　要：目的探讨大的结直肠肿瘤经内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗的结局,并分析影响ESD疗效的因素。方法从2016年11月—2019年12月在北京医院消化内科行ESD治疗的结肠肿瘤患者中,筛选出病变长径≥20 mm、活检病理为结直肠腺瘤或腺癌的患者共82例,收集分析患者的临床特点、ESD及病理结果等资料。结果82例患者病变均为单发,病变长径(29.72±10.74)mm,分为侧向发育型肿瘤(laterally spreading tumors,LST)组46例,主要位于升结肠及回盲部(47.8%,22/46);腔内突出型肿瘤组36例,病变均位于左半结肠,其中约一半位于乙状结肠(52.8%,19/36)。总体的整块切除率81.7%(67/82),治愈性切除率72.0%(59/82),出血和穿孔的发生率分别为2.4%(2/82)和1.2%(1/82)。LST-G、LST-NG、腔内突出型肿瘤3组的治愈性切除率[91.4%(32/35)、63.6%(7/11)、55.6%(20/36),P=0.003]和外科手术率[8.6%(3/35)、18.2%(2/11)和36.1%(13/36),P=0.010]差异均有统计学意义。多因素回归分析结果显示,病变形态为腔内突出型肿瘤(OR=3.396,95%CI:1.014~11.374,P=0.047)和黏膜下层重度纤维化(F2型)(OR=5.508,95%CI:2.216~13.692,P=0.001)是长径≥20 mm结直肠肿瘤ESD非治愈性切除的独立危险因素。结论ESD治疗长径≥20 mm的结直肠肿瘤总体有效、安全,但不同类型病变的黏膜下侵犯比例和治疗结局存在一定差异,腔内突出型肿瘤和严重的黏膜下层纤维化是造成非治愈性切除的危险因素。Objective To evaluate the outcome of endoscopic submucosal dissection(ESD)of colorectal tumors,and to analyze the factors affecting the therapeutic efficacy of ESD.Methods Clinical data of patients with colorectal tumors who were treated with ESD in Department of Gastroenterology in Beijing Hospital from November 2016 to December 2019 were reviewed.A total of 82 patients with pathologically confirmed colorectal adenoma or carcinoma of diameter≥20 mm were included.The clinical features,ESD and pathological outcomes of the patients were analyzed.Results All 82 lesions were single,with the mean diameter of 29.72±10.74 mm.Lesions were divided into the laterally spreading tumors(LST),mainly located in the ascending colon and ileocecal region(47.8%,22/46)and the protruding colorectal tumors,mainly located in the left colon,52.8%(19/36)of which were located in the sigmoid colon.The overall resection rate was 81.7%(67/82)and the curative resection rate was 72.0%(59/82).The incidences of bleeding and perforation were 2.4%(2/82)and 1.2%(1/82),respectively.The curative resection rates[91.4%(32/35),63.6%(7/11)and 55.6%(20/36),P=0.003]and surgical operation rates[8.6%(3/35),18.2%(2/11)and 36.1%(13/36),P=0.010]of LST-G,LST-NG and protruding colorectal tumors were significantly different.Multivariate regression analysis showed that protruding colorectal tumor(OR=3.396,95%CI:1.014-11.374,P=0.047)and submucosal severe fibrosis(F2 type)(OR=5.508,95%CI:2.216-13.692,P=0.001)were independent risk factors for non-curative ESD resection of colorectal tumors.Conclusion ESD is effective and safe for colorectal tumors of diameter≥20 mm.However,there are some differences in the rate of submucosal invasion and treatment outcome among different types of lesions.The risk factors for non-curative resection are protruding tumors and severe submucosal fibrosis.

关 键 词：结直肠肿瘤 侧向发育型肿瘤 腔内突出型肿瘤 内镜黏膜下剥离术 

分 类 号：R735.34[医药卫生—肿瘤]