早期结直肠癌及其癌前病变内镜黏膜下剥离术非治愈性切除的危险因素分析  

Analysis of Risk Factors of Non⁃curative Resection of Endoscopic Submucosal Dissection for Early Colorectal Cancer and Precancerous Lesions

作　　者：李文彬 张晓宇 徐雪 杜俊[2] 罗庆锋[1] 史济华[1] LI Wenbin;ZHANG Xiaoyu;XU Xue;DU Jun;LUO Qingfeng;SHI Jihua(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]北京医院消化内科,国家老年医学中心、中国医学科学院老年医学研究院,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,100730

出　　处：《胃肠病学》2022年第9期513-517,共5页Chinese Journal of Gastroenterology

基　　金：中央高水平医院临床科研业务费(BJ⁃2021⁃233)。

摘　　要：背景:目前国内尚缺乏内镜黏膜下剥离术(ESD)非治愈性切除早期结直肠癌及其癌前病变的危险因素的大宗临床研究。目的:分析ESD治疗早期结直肠癌及其癌前病变的疗效,探索影响非治愈性切除的危险因素。方法:收集2016年9月-2021年9月北京医院行ESD治疗的早期结直肠癌及其癌前病变患者共229例,分析患者的临床病理特征、ESD疗效。采用单因素分析和Logistic多因素回归分析评估影响ESD非治愈性切除的危险因素。结果:共发现255处病变,整块切除率为90.2%,R0切除率为87.8%,治愈性切除率为83.5%,并发症发生率为2.7%。单因素分析结果显示非治愈性切除组腔内突出型肿瘤检出率(61.0%对24.4%,P<0.05)、黏膜下层重度纤维化率(24.4%对2.4%,P<0.05)显著高于治愈性切除组,而抬举征阳性率明显降低(80.5%对95.1%,P<0.05)。Logistic多因素回归分析结果显示腔内突出型肿瘤(OR=4.087,95%CI:1.523~10.968,P=0.005)、黏膜下层重度纤维化(OR=9.609,95%CI:1.107~83.439,P=0.04)是早期结直肠癌及其癌前病变ESD非治愈性切除的危险因素。结论:ESD治疗早期结直肠癌及其癌前病变的R0切除率和治愈性切除率高,手术并发症发生率低。腔内突出型肿瘤、黏膜下层重度纤维化是肿瘤非治愈性切除的独立危险因素,术前应进行严格评估,制定合理的治疗策略。Background:The risk factors affecting the non⁃curative resection of endoscopic submucosal dissection(ESD)for early colorectal cancer and precancerous lesions were still lacking large scale studies in China.Aims:To analyze the efficacy of ESD for patients with early colorectal cancer and precancerous lesions,and explore the risk factors affecting the non⁃curative resection.Methods:A total of 229 patients with early colorectal cancer and precancerous lesions underwent ESD from September 2016 to September 2021 at Beijing Hospital were collected.The clinicopathological characteristics,efficacy of ESD were analyzed.Risk factors affecting the non⁃curative resection of ESD were analyzed by univariate analysis and Logistic multivariate regression analysis.Results:A total of 255 lesions were found.The en bloc resection rate was 90.2%,R0 resection rate was 87.8%,and curative resection rate was 83.5%.The total incidence of complications was 2.7%.Univariate analysis showed that detection rate of intraluminal protruding tumor(61.0%vs.24.4%,P<0.05),rate of severe submucosal fibrosis(24.4%vs.2.4%,P<0.05)were significantly increased in the non⁃curative resection group than in the curative resection group,and positive rate of lifting sign was significantly decreased(80.5%vs.95.1%,P<0.05).Logistic multivariate regression analysis showed that intraluminal protruding tumor(OR=4.087,95%CI:1.523⁃10.968,P=0.005)and severe submucosal fibrosis(OR=9.609,95%CI:1.107⁃83.439,P=0.04)were risk factors for ESD non⁃curative resection of early colorectal cancer and precancerous lesions.Conclusions:R0 resection rate and curative resection rate of ESD for early colorectal cancer and precancerous lesions are high,the incidence of surgical complications is low.Intraluminal protruding tumor,severe submucosal fibrosis are the independent risk factors of non⁃curative resection.Strict evaluation should be carried out before operation and reasonable treatment strategies should be formulated accordingly.

关 键 词：结直肠肿瘤 癌前病变 内镜黏膜下剥离术 非治愈性切除 危险因素 

分 类 号：R735.34[医药卫生—肿瘤]