内镜黏膜下剥离术治疗早期结直肠癌及癌前病变的非整块切除影响因素分析  

Factors Associated With Non-en bloc Resection of Endoscopic Submucosal Dissection for Colorectal Neoplasms

作　　者：张渝昕 刘珣[1] 顾芳[1] 丁士刚[1] Zhang Yuxin;Liu Xun;Gu Fang(Department of Digestive Diseases,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院消化科,北京100191

出　　处：《中国微创外科杂志》2023年第12期885-890,共6页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗结直肠肿瘤发生非整块切除的影响因素。方法回顾性收集2011年1月~2022年12月结直肠ESD临床病理资料,经病理证实为腺瘤、锯齿状病变、早期结肠癌共1251例患者1312个病变,比较整块切除组与非整块切除组的临床病理特征,采用单因素及多因素logistic回归分析ESD非整块切除的影响因素。结果1312个病变长径(25.8±16.3)mm。腺瘤728个(55.5%),锯齿状病变193个(14.7%),腺癌391个(29.8%)。1306个病变完成ESD治疗,因穿孔或操作困难中止切除6个。病变整块切除率89.5%(1174/1312),完全切除率73.8%(968/1312),治愈性切除率70.6%(926/1312)。多因素logistic分析显示,病变长径≥40 mm(OR=6.329,95%CI:4.278~9.384,P<0.001)、抬举征阴性(OR=2.384,95%CI:1.424~3.903,P=0.005)、瘢痕部位病变(OR=2.997,95%CI:1.310~6.484,P=0.023)、隆起型(OR=8.458,95%CI:2.678~40.453,P=0.008)、侧向发育型(OR=5.898,95%CI:1.917~27.796,P=0.025)、混合ESD切除(OR=10.162,95%CI:5.705~19.692,P<0.001)是ESD治疗早期结直肠癌及癌前病变非整块切除的独立影响因素。结论病变长径≥40 mm、抬举征阴性、瘢痕部位病变、隆起型病变、侧向发育型病变、混合ESD切除是ESD非整块切除结直肠肿瘤的独立影响因素,术前应进行严格评估,提高ESD的疗效。Objective To explore factors influencing non-en bloc resection of endoscopic submucosal dissection(ESD)for colorectal neoplasms.Methods A retrospective analysis was conducted on clinical and pathological data of 1251 patients(1312 lesions)who underwent colorectal ESD from January 2011 to December 2022 and were pathologically confirmed as adenoma,serrated lesion,or early colorectal cancer.Clinical and pathological characteristics were compared between the en bloc resection group and the non-en bloc resection group.Univariate and multivariate logistic regression analyses were performed to identify factors influencing en bloc resection in ESD.Results The average size of the 1312 lesions was(25.8±16.3)mm.Among the included lesions,there were 728 adenomas(55.5%),193 serrated lesions(14.7%),and 391 early colorectal cancers(29.8%).ESD was completed in 1306 lesions and stopped due to perforation or technical difficulties in 6 cases.The en bloc resection rate was 89.5%(1174/1312),the complete resection rate was 73.8%(968/1312),and the curative resection rate was 70.6%(926/1312).Multivariate logistic regression analysis revealed that diameter of the lesions≥40 mm(OR=6.329,95%CI:4.278-9.384,P<0.001),negative lifting sign(OR=2.384,95%CI:1.424-3.903,P=0.005),scar location lesions(OR=2.997,95%CI:1.310-6.484,P=0.023),protruded lesions(OR=8.458,95%CI:2.678-40.453,P=0.008),lateral spreading lesions(OR=5.898,95%CI:1.917-27.796,P=0.025),and hybrid ESD(OR=10.162,95%CI:5.705-19.692,P<0.001)were independent factors influencing en bloc resection of ESD for early colorectal cancer and precancerous lesions.Conclusions Diameter of the lesions≥40 mm,negative lifting sign,scar location lesions,protruded lesions,lateral spreading lesions,and hybrid ESD were significantly associated with non-en bloc resection of ESD for colorectal neoplasms.Strict evaluation should be conducted preoperatively to improve the efficacy of ESD.

关 键 词：内镜黏膜下剥离术 早期结直肠癌 腺瘤 有效性 完全切除 

分 类 号：R735.3[医药卫生—肿瘤]