影响结直肠肿瘤内镜下黏膜切除术预后的多因素分析

A multivariate analysis of postoperative complications after endoscopic mucosa resection in management of colorectal lesion

目的研究内镜下黏膜切除术(EMR)治疗结直肠病变的并发症及危险因素。方法回顾性分析了南京中医药大学第三附属医院肛肠医疗中心2004年10月至2007年10月共进行EMR术84例94枚结直肠病变,对可能影响EMR术后并发症的因素进行Logistic回归分析。结果84例患者,男性56例、女性28例,平均年龄(57±13)岁(30～85岁),术前病理检查诊断为结肠腺瘤69枚(73.4%)、绒毛状腺瘤4枚(4.3%)、管状绒毛状腺瘤17枚(18.1%)、结肠腺瘤癌变2枚(2.1%)、结直肠类癌2枚(2.1%),息肉平均大小(15±7)mm(10～40mm)。平均随访时间(25±7)个月(3～36个月)。4例(4.3%)患者发生术中或术后出血、3例(3.2%)发生息肉复发,总并发症发生率为6.4%,并发症的发生与病变的大小、是否需要分次切除及是否为绒毛状腺瘤有关,多因素分析提示病变大于20mm是EMR术后并发症发生的独立的危险因素。结论结肠病变大于20mm是EMR术后并发症发生的独立的危险因素,对于大于20mm的结肠病变、特别不能整块切除的病变在进行EMR切除时需要慎重,术后要加强随访。

Objective To investigate the postoperative complications of EMR in management of colorectal lesion and the risk factors related to the complications. Methods From October 2004 to October 2007, 94 colorectal lesions in 84 patients were treated by EMR at the National Center of Colorectal Surgery, the 3rd Affiliated Hospital of Nanjing University of TCM. Data were analyzed retrospectively and related risk factors were analyzed by logistic regression. Results In the 84 patients, 56 were male and 28 were female. Their average age was 57 ± 13 years（ range 30 - 85 years ）. Sixty-nine lesions were adenoma, 4 were villous adenoma , and 17 were both. Two adenomas were cancerated and two were carcinoid. Average size of tumors was 15 ± 7 mm （ range 10 ±40 mm. Average follow-up time was 25 ±7 months （ range 3 - 36 months）. EMR postoperative complication was related to lesion size, pathological type, and en bloc resection or not. Lesions of over 20 mm were independent risk factors of EMR complications. Conclusions Lesion of over 20 mm is an independent risk factor of EMR postoperative complications. Those lesions of over 20 mm that can not be removed by en bloc resection should be treated cautiously and followed up carefully.