早期结直肠癌患者行内镜黏膜下剥离术的手术难度影响因素分析

Factors associated with surgical difficulty of endoscopic submucosal dissection in patients with colorectal cancer

目的分析早期结直肠癌患者行内镜黏膜下剥离术手术难度的影响因素。方法回顾性分析本院70例经内镜黏膜下剥离术治疗的早期结直肠癌患者的临床资料,手术难度以手术时间为标准,手术时间<60 min为难度小的手术,手术时间≥60min为难度大的手术,对患者基本资料(性别、年龄、肿瘤直径、病变部位、纤维化、肿瘤类型、肿瘤分化程度)行单因素、Logistic多因素回归分析,探讨其对手术难度的影响。结果本次研究中手术难度大的患者共9例,手术难度小的患者共61例。单因素分析结果显示,肿瘤直径、病变部位、纤维化、肿瘤类型与手术难度有关(P<0.05)。Logistic多因素回归分析结果显示,肿瘤直径≥40mm、左半结肠肿瘤、重度纤维化、侧向发育型肿瘤是手术难度的独立危险因素(P<0.05)。结论肿瘤直径≥40 mm、左半结肠、重度纤维化、侧向发育型肿瘤易延长手术时间,增加手术难度,需引起临床重视。

Objective To determine factors affecting the surgical difficulty of endoscopic submucosal dissection in patients with colorectal cancer. Methods 70 patients of colorectal cancer treated with endoscopic submucosal dissection in our hospital were analyzed retrospectively. The difficulty of operation was measured using the standard of operation time. The operation time is less than60 min. Patients were categorized as with small difficulty operation（operation time〈 60 min） and great difficulty operation（operation time ≥ 60 min）. Univariate and logistic regression analysis was performed with sex, age, tumor diameter, lesion site, fibrosis and tumor types of the patients, tumor differentiation and tumor TNM staging as possible predictors associated with operation difficulty.Results In this study, 9 patients were difficult to operate, and 61 patients were relatively easy to operate. Unianalysis showed that tumor diameter, lesion location, fibrosis and tumor type were significantly associated with the operation difficulty（P〈 0.05）.Multivariate Logistic regression analysis showed that tumor diameter, tumor occurring at the left colon, severe fibrosis and lateral developmental tumor were independent risk factors for operation difficulty（P 〈0.05）. Conclusion The tumor diameter ≥ 40 mm, tumor occurring at the left colon, severe fibrosis, laterally spreading tumor can prolong the operation time and increase the difficulty of operation. Cautions should be made for such patients.