内镜黏膜下剥离术治疗直肠侧向发育型肿瘤的疗效分析

Efficacy Observation of Endoscopic Submucosal Dissection in Rectal Laterally Spreading Tumors

目的:评估内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗直肠侧向发育型肿瘤(laterally spreading tumors,LSTs)的疗效及安全性。方法:回顾分析20例直肠LSTs患者的临床资料。根据内镜下直肠黏膜表面形态对LSTs进行分型,统计肿瘤大小、形态特征、病理特点以及ESD治疗的切除率和手术时间,并且随访分析手术后的并发症和复发情况。结果:20例中,LSTs分型为颗粒型8例,非颗粒型12例;腺瘤伴有低级别瘤变18例,高级别上皮内瘤变2例;管状绒毛状腺瘤7例,管状腺瘤13例;平均病变直径为(33.9±11.5)mm;ESD治疗时整块、完整切除率为100%,平均手术时间为(40±15)min。手术后,出血发生率为10%(2/20),无穿孔发生;在平均12.6个月随访时间内,未发现复发。结论:ESD治疗直肠LSTs病变的整块切除率高,并发症发生率低。因此,ESD是治疗直肠LSTs(尤其是病变直径大于2 cm、具有较高恶变潜能的LSTs)的一种安全有效的方法。

Objective：To evaluate the efficacy and safety of endoscopic submucosal dissection（ESD）in the treatment of rectal laterally spreading tumors（LSTs）.Methods：The clinical data of 20 patients with LSTs,who were admitted in Jiangyin Traditional Chinese Medicine Hospital from September 2012 to September 2014,were retrospectively analyzed.According to the superficial morphology of rectal mucosa,the subtypes of LSTs were determined by endoscopy.Tumor size and morphological characteristics,pathological features and operation time of ESD were counted.Furthermore,postoperative complications and recurrence were followed up and statistically analyzed.Results：There were 8（40%）cases of LST granular type and 12（60%）cases of LST nongranular type.There were 18 cases of adenomas associated with low grade neoplasia and 2（10%）cases of high grade intraepithelial neoplasia.There were 7 cases of tubulovillous adenoma and 13 cases of tubular adenoma.The mean diameter of lesions was（33.9±11.5）mm.The enbloc resection rate was 100% and the average time of ESD operations was（40±15）min.The postoperative bleeding rate was 10%（2/20）and no perforation occurred.The mean follow-up period was12.6 months,during which no recurrence was found.Conclusions：With high enbloc resection rate and low complication rate,ESD is a safe and efficacious treatment for rectal LSTs,especially for the lesions larger than2 cm which have higher potential of malignancy.