内镜黏膜下剥离术治疗老年结直肠早期癌症及癌前病变的疗效分析  

Analysis of the efficacy of endoscopic submucosal dissection in the treatment of early colorectal cancer and precancerous lesions in the elderly

作　　者：孙娜 邓敏娟 赖莘秀 王祥[2] SUN Na;DENG Min-juan;LAI Xin-xiu;WANG Xiang(The Second Clinical Medical College of Lanzhou University,Lanzhou,Gansu,730000;Department of Gastroenterology,Lanzhou University Second Hospital,Lanzhou,Gansu,730030)

机构地区：[1]兰州大学第二临床医学院,730000 [2]兰州大学第二医院消化科,730030

出　　处：《现代消化及介入诊疗》2023年第7期813-817,822,共6页Modern Interventional Diagnosis and Treatment in Gastroenterology

基　　金：甘肃省科技计划项目(21YF5FA124)。

摘　　要：目的探讨分析老年结直肠早期癌症及癌前病变内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗的疗效与安全性。方法:回顾性分析2019年1月至2022年12月期间在兰州大学第二医院内镜中心行ESD治疗的结直肠早期癌症及癌前病变183例患者(195个病灶)的临床资料,分为中青年组(<60岁)和老年组(≥60岁)。对比两组患者的基线资料、实验室指标、病变特征、整块切除率、完全切除率及并发症发生率。结果:老年组患者年龄高于中青年组,肿瘤家族史少于中青年组,差异具有统计学意义(P<0.05)。两组间PLT、UREA、CREA、INR、FIB及DD差异具有统计学意义(P<0.01),其他实验室指标差异均无统计学意义。中青年组有2%(2/95)的病灶合并瘢痕,老年组有9.7%(9/88)的病灶合并瘢痕,差异具有统计学意义(P=0.027)。老年组和中青年组病变内镜下分型均以隆起型为主,差异具有统计学意义(P<0.05),病理类型均以腺瘤为主,差异具有统计学意义。(P>0.05)。老年组患者的整块切除率(95.7%比99%,P=0.312)、完全切除率(78.5%比69.6%,P=0.312)、术后并发症率(17.2%比14.7%,P=0.634)、手术时间[41.00(22.50,70.00)比35.00(20.00,57.750),P=0.190]、切除速度[0.13(0.07,0.23)比0.12(0.07,0.24),P=0.589]、住院时间[9.00(2.00,12.75)比9.00(2.00,12.00),P=0.599]、术后住院时间[4.00(5.00,6.00)比4.00(5.00,6.00),P=0.133]及住院费用[16695.69(14488.36,21062.76)比16565.99(13842.38,19526.45)]差异均无统计学意义。结论:ESD治疗老年患者结直肠早期癌症及癌前病变是安全有效的。Objective To explore and analyse the efficacy and safety of endoscopic submucosal dissection(ESD)treatment for colorectal early cancers and precancerous lesions in the elderly.Methods Clinical data of 183 patients(195 lesions)with colorectal early cancers and precancerous lesions who underwent ESD at the Endoscopy Centre of the Second Hospital of Lanzhou University between January 2019 and December 2022 were retrospectively analysed and divided into the young and middle-aged group(<60 years old)and the elderly group(≥60 years old).The baseline data,laboratory indexes,lesion characteristics,whole resection rate,complete resection rate and complication rate of the two groups were compared.Results The age of patients in the elderly group was higher than that of the young and middle-aged group,and the family history of tumour was less than that of the young and middle-aged group,and the difference was statistically significant(P<0.05).The differences in PLT,UREA,CREA,INR,FIB and DD between the two groups were statistically significant(P<0.01),while the differences in other laboratory indicators were not statistically significant.Two percent(2/95)of the lesions in the young and middle-aged group were combined with scarring,and 9.7%(9/88)of the lesions in the elderly group were combined with scarring,and the difference was statistically significant(P=0.027).The endoscopic typing of lesions in both the elderly and young and middle-aged groups was predominantly augmented,with a statistically significant difference(P<0.05),and the pathological types were predominantly adenomas,with a statistically significant difference.(P>0.05).The whole resection rate(95.7%versus 99%,P=0.312),complete resection rate(78.5%versus 69.6%,P=0.312),postoperative complication rate(17.2%versus 14.7%,P=0.634),operative time[41.00(22.50,70.00)versus 35.00(20.00,57.750),for patients in the elderly group P=0.190],speed of resection[0.13(0.07,0.23)versus 0.12(0.07,0.24),P=0.589],length of hospital stay[9.00(2.00,12.75)versus 9.00(2.00,12.00),P=0.5

关 键 词：内镜黏膜下剥离术 老年人 结直肠早期癌症 安全性 并发症 

分 类 号：R574.6[医药卫生—消化系统]