内镜黏膜下剥离术治疗早期结直肠癌及其癌前病变的临床分析

Therapeutic efficacy and safety of endoscopic submucosal dissection for early colorectal carcinoma and precancerous lesions

目的评价ESD治疗早期结直肠癌及其癌前病变的疗效及安全性。方法对21例早期结直肠癌及其癌前病变行ESD者的临床资料进行回顾性分析，分析其临床病理特征、完整切除率、治愈性切除率、并发症发生情况及随访情况。结果病灶分布于左半结肠者最多，占80．9％（17／21）；内镜下隆起型（Ⅰ型）所占比例最高（61．9％，13／21），平坦型所占比例最少（14．3％，3／21）；操作时间为35～120min，中位时间为79min；整块切除率为100．0％（21／21），治愈性切除率为85．7％（18／21）；迟发性出血率为4．7％（1／21），术后感染率为4．7％（1／21），无穿孔病例。术后病理分型管状腺瘤伴高级别上皮内瘤变所占比例最高（33．3％，7／21），绒毛状腺瘤伴高级别上皮内瘤变所占比例最低（4．7％，1／21）。随访3—20个月，无局部复发和远处转移。结论ESD治疗早期结直肠癌及其癌前病变安全、有效、微创，具有广阔的临床应用前景。

Objective To evaluate the therapeutic effectiveness and safety of endoscopic submucosal dissection（ESD） for early colorectal carcinoma and its precancerous lesions. Methods The clinical pathologi- cal characteristics, en bloc resection rate,curative resection rate ,complications and follow-up results of 21 pa- tients with early colorectal carcinoma or precancerous lesions, who were treated by ESD, were retrospectively analyzed. Results Most lesions were located in left colon,which accounted for 80. 9%（17/21） .The most com- mon macroscopic morphology（Type Ⅰ） was protrusion type （61.9%, 13/21 ）, while fiat type was the least （14. 3%,3/21 ）.The mean procedure time was 79（35-120） min. The en blot resection rate was 100. 0% （21/21）, and curative resection rate was 85.7% （18/21）. Postoperative hemorrhage occurred in 1 patient （4. 7% ,1/21） and postoperative infection occurred in 1（4. 7%, 1/21） and no perforation was recorded. Tubu- lar adenoma with high-grade intraepithelial neoplasia（LGIEN） was the most occurence（ 33. 3% ,7/21 ） ,villous adenoma with LGIEN was the least （4.7%, 1/21 ）. No local recurrence or metastasis was observed during follow-up of 3-20 months. Conclusion ESD is safe, effective, minimal invasive for early colorectal carcinoma and its precancerous lesions, with optimistic prospect of clinical application.