早期结直肠癌内镜非治愈性切除补充外科根治性手术的必要性分析  

Salvage radical surgery in early-stage colorectal cancer patients undergoing non-curative endoscopic resection

作　　者：丰硕 窦伟冬 武颖超[1] 陈国卫[1] 吴涛[1] 姜勇[1] 王鹏远[1] 张继新[2] 蔡云龙[3] 戎龙[3] 张峻岭[1] 汪欣[1] Feng Shuo;Dou Weidong;Wu Yingchao;Chen Guowei;Wu Tao;Jiang Yong;Wang Pengyuan;Zhang Jixin;Cai Yunlong;Rong Long;Zhang Junling;Wang Xin(Department of Gastrointestinal Surgery,Peking University First Hospital,Beijing 100034,China;Department of Pathology,Peking University First Hospital,Beijing 100034,China;Department of Endoscopy Center,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院胃肠外科,北京100034 [2]北京大学第一医院病理科,北京100034 [3]北京大学第一医院内镜中心,北京100034

出　　处：《中华普通外科杂志》2024年第2期81-85,共5页Chinese Journal of General Surgery

基　　金：国家自然科学基金面上项目(8237110234);国家自然科学基金(81641098);国家重大疾病多学科合作诊疗能力建设项目;北京大学第一医院青年临床研究专项基金(2021CR03);北京大学医学部青年培育基金(BMU2020PYB026)。

摘　　要：目的探讨早期结直肠癌内镜非治愈性切除后追加外科根治性手术的必要性。方法回顾性分析2011年1月至2021年12月期间于北京大学第一医院普通外科经内镜非治愈性切除后追加外科手术的104例早期结直肠癌患者的临床病理资料。结果104例患者中在内镜切除后23例(22%)出现淋巴结转移和(或)有残留癌,其中单纯淋巴结转移12例,单纯残留癌7例,淋巴结转移和残留癌均有4例。单因素分析显示,脉管侵犯、垂直切缘阳性、女性是淋巴结转移的危险因素;肿瘤直径≥2 cm、抬举征阴性、浸润深度≥1000μm、水平切缘阳性、垂直切缘阳性是残留癌的危险因素。多因素Logistic回归分析显示,脉管侵犯、垂直切缘阳性、女性是淋巴结转移的独立危险因素,垂直切缘阳性是残留癌的独立危险因素。104例患者中位手术时间184(156~233)min,中位术中失血量50(20~100)ml,中位术后住院时间9(8~11)d。出现Clavein-dindoⅡ级以上并发症共7例,其中肺栓塞1例,吻合口瘘1例,淋巴瘘1例,肠梗阻2例,泌尿系感染2例。结论外科手术是早期结直肠癌内镜下非治愈性切除的补救措施。Objective To evaluate whether additional radical surgery is necessary following non-curative endoscopic resection of early colorectal cancer.Method Clinicopathological data in 104 patients following non-curative endoscopic resection of early colorectal coucer at the Department of General Surgery,Peking University First Hospital between Jan 2011 and Dec 2021.Results Lymph node metastasis and/or residual cancer was found in 23 patients(22%),including 12 cases of lymph node metastasis,7 cases of residual cancer and 4 patients with both residual cancer and lymph node metastasis.Univariate analysis indicated that vascular infiltration,positive vertical margin,and female gender were risk factors for lymph node metastasis.Risk factors for residual cancer were tumors≥2 cm in size,negative lift sign,infiltration depth of≥1000μm,and positive horizontal and vertical margins.Multivariate Logistic regression analysis revealed that vascular invasion,positive vertical margins,and being female were independent risk factors for lymph node metastasis,while positive vertical margins was independent risk factor for residual cancer.Salvage surgery lasted for a median of 184(156-233)minutes,with an estimated blood loss of 50(20-100)ml and an average postoperative hospital stay of 9(8-11)days.Seven cases of Clavein-DindoⅡor higher complications were observed,including pulmonary embolism in 1 case,anastomotic leakage in one,lymphatic fistula in one,bowel obstruction in 2 cases and urinary tract infection in 2 cases.Conclusion Salvage surgery is mandatory for early endoscopic non-curative resection of colorectal cancer.

关 键 词：结直肠肿瘤 内镜下黏膜切除术 外科手术 

分 类 号：R735.34[医药卫生—肿瘤]