内镜智能分光比色技术定位下EMR及ESD治疗大肠侧向发育型肿瘤的疗效比较

Clinical observation of EMR and ESD in treating laterally spreading tumor by FICE

[目的]比较内镜智能分光比色技术(FICE)定位下内镜下黏膜切除术(endoscopic mucosal resection,EMR)及内镜黏膜下剥离术(endoscopic submucasal dissection,ESD)治疗大肠侧向发育型肿瘤(LST)的效果。[方法]63例LST患者在FICE定位下分别行EMR(38例)及ESD(25例)治疗,对比分析EMR和ESD两种方法的切除效果、手术时间及并发症。[结果]对于最大径≤20mm的肿瘤,EMR和ESD两种方法均能整块切除,且无肿瘤残留(P>0.05);对于最大径>20mm的肿瘤,ESD能整块切除,EMR需分次切除(P<0.05),且ESD术后肿瘤残留明显少于EMR(P<0.05)。ESD手术时间明显长于EMR(P<0.05),但术后出血率和穿孔率,两者比较差异无统计学意义(P>0.05)。[结论]ESD治疗LST安全有效,而EMR操作简便,用时较短,对于≤20mm的LST仍然是一种较好的选择。

[Objective]To assess the therapeutic effect and safety of endoscopic mucosal resection（EMR） and endoscopic submucosal dissection（ESD）for the treatment laterally spreading tumor（LST）by Fuji intel- ligent chromoendoscopy（FICE）locating. [Methods]Sixty-three cases of LST were treated by EMR or ESD through FICE,and the therapeutic effects,operating time and complication were compared after the resec- tion. [Results]For the tumor maximum diameter less than 20 mm, EMR and ESD could equally get high complete resection rate,and there was no residual tumor（P〉 0. 05）,however,for the tumor maximum di- ameter greater than 20 mm, ESD could get high complete resection rate,EMR need fractionated resection（P 〈0. 05）,furthermore,the residual tumor of ESD group was less than EMR group. The operating time of ESD group was significantly longer than the EMR group（P〈0.05）,but there was no significant difference of bleeding rate and perforation rate between the two methods（P〉0. 05）. [Conclusion]ESD is an effective and safe endoscopic surgical procedure to resect laterally spreading tumor. But EMR is simple, and needs less time,so EMR is still a better choice for lesions smaller than 20 mm.