内镜黏膜下剥离术在老年人结直肠病变中的治疗价值评价

Endoscopic submucosal dissection for colorectal lesions in elderly patients

目的：探讨内镜黏膜下剥离术治疗老年人（≥60岁）结直肠病变的有效性和安全性。方法对2012年1月至2014年1月经肠镜检查发现结直肠隆起性病变，并行内镜黏膜下剥离术治疗的31例老年患者（≥60岁）和23例非老年患者（＜60岁）进行回顾性比较分析。结果2组在性别比例、伴随疾病、病灶部位、病灶大小以及术后病理结果上差异均无统计学意义（P 均＞0.05）。老年组32个病灶，非老年组25个病灶，57个病灶均为治愈性切除。老年组病灶完整切除率96.9％（31／32），非老年组96.0％（24／25）；老年组术中出血发生率3.2％（1／31），非老年组4.3％（1／23）；老年组迟发性出血发生率12.9％（4／31），非老年组13.0％（3／23）；老年组穿孔发生率12.9％（4／31），非老年组为0；老年组术后感染发生率3.2％（1／31），非老年组4.3％（1／23），组间差异均无统计学意义（P 均＞0.05）。随访时间老年组（14.8±1.7）个月和非老年组（14.7±1.8）个月，组间差异无统计学意义（P ＝0.801）。随访过程中均未发现病灶残留或复发。结论内镜黏膜下剥离术治疗60岁以上老年人结直肠病变是安全有效的。

Objective To investigate the safety and effectiveness of endoscopic submucosal dissection（ESD）for elderly patients（≥60 years old）with colorectal lesions.Methods Data of 31 elderly patients（≥60 years old）and 23 non-elderly（〈60 years old）patients who were found to have colorectal mucosal lesions by colonoscopy and underwent ESD treatment between January 2012 to January 2014 were retrospectively studied.Results There were no statistical differences between the two groups in gender, concomitant diseases,lesion location,lesion size and postoperative pathological diagnosis （P ＆gt;0.05 ）. Thirty-two lesions in elderly group and twenty-five lesions in non-elderly group were all curative resection.En bloc resection rates were 96.9%（31 /32）and 96.0%（24 /25）in the elderly group and non-elderly group respectively;the rates of bleeding during ESD procedure were 3.2%（1 /31 ）and 4.3%（1 /23）;delayed bleeding rates were 12.9%（4 /31）and 13.0%（3 /23）;the rates of perforation was 12.9%（4 /31）and 0;postoperative infection rates were 3.2%（1 /31）and 4.3%（1 /23）respectively.There were no statistical differences between the two groups in any of these data （P〉0.05 ）.The mean time of follow-up were （14.8 ±1.7）months in elderly group and （14.7 ±1.8）months in non-elderly group,and there was no significant difference between two groups.No residual lesion or recurrent lesion was found in the follow-up period.Conclusion ESD is a safe and effective treatment for the elderly patients with colorectal lesion.