结直肠肿瘤内镜黏膜下剥离术(ESD)手术时间的影响因素分析

Factors Affecting the Procedure Time of Endoscopic Submucosal Dissection for Colorectal Cancer

目的分析ESD治疗结直肠肿瘤的手术时间的影响因素。方法回顾性分析210例结直肠癌肿瘤患者ESD治疗的临床资料。将手术时间分为≥60 min和<60 min两部分,采用逻辑回归分析对包括肿瘤部位、类型、病理诊断、非抬举征、术中严重出血等5个变量进行分析。结果 210例结直肠ESD平均手术时间(50.3±42.8)min,病灶平均大小(31.9±44.9)cm^2,整块切除率为91.4%,R0切除率为90.5%,治愈性切除率为88.6%。穿孔发生率为5.2%(11/210),迟发性出血率为0.5%(1/210)。多因素回归分析提示,肿瘤直径≥40 mm或跨结肠袋(OR 3.466;95%CI:1.594~7.538)、病变位于弯曲部(OR 2.270;95%CI:0.175~9.227)是影响结直肠ESD手术时间的独立危险因素(时间≥60min)。结论结直肠肿瘤直径≥40 mm或跨结肠袋,病变位于弯曲部可明显延长ESD手术时间,使手术难度增加。

Objective To evaluate the factors affecting the procedure time of endoscopic submucosal dissection （ESD） for colorectal cancer. Methods Clinical data of 210 cases of colorectal cancer were analyzed retrospectively. They were divided into 2 groups according to procedure time （ 1〉60 rain and 〈 60 min）. Tumor location, tumor type, pathological diagnosis, nollifting sign and severe bleeding were assessed, and multivariate analysis was performed to identify factors associated with the duration of ESD. Results Mean procedure time was （50.3 ± 42.8 ） minutes, mean tumor size was （31.9 ± 44.9） cm2. En bloc resection rate, R0 resection rate and curative resection rate was 91.4% ,90.5% and 88.6% respectively. Perforation occurred in 11 cases （5.2 % ）. Delayed bleeding was seen in 1 case （0.5 % ）. Multivariate analysis confirmed that tumor size 〉40 mm or cross-colos- tomy bags OR：3. 466 ;95% CI： 1. 594 ± 7. 538, and tumor location of colorectal flexure OR：2.270 ;95% C1：0. 175 N 9. 227 were independent risk factors for procedure time in colorectal ESD（time〉60 min）. Conclusion Colorectal tumor 〉40 mm or cross- colostomy bags x2 folds or colorectal flexure takes longer procedure time and increases the technical difficulty.