内镜黏膜下剥离术与根治性手术治疗直径大于5 cm的大肠侧向发育型肿瘤的疗效及安全性比较

Comparison of the efficacy and safety between endoscopic submucosal dissection and radical surgery for large colorectal laterally spreading tumors larger than 5 cm in diameter

目的:比较内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)与根治性手术(radical surgery,RS)治疗直径>5 cm的大肠侧向发育型肿瘤(laterally spreading tumor,LST)的疗效和安全性。方法:收集中南大学湘雅二医院2011年1月至2016年1月确诊的82例直径>5 cm的无深部黏膜下浸润的大肠LST患者(T1 SM2,≥1 000μm),其中52例接受ESD治疗,30例接受RS(包括腹腔镜辅助结肠切除术和开腹结肠切除术)治疗。回顾性分析患者的临床资料并比较两组患者的整块切除率、整块R0切除率、局部复发率、并发症、手术时间和住院时间。结果:ESD组和RS组病灶大小分别为(5.80±1.20) cm和(5.53±0.69) cm(P>0.05)。两组整块切除率、整块R0切除率和局部复发率差异均无统计学意义(P>0.05)。ESD组并发症发生率(7.69%,4/52)明显低于根治性手术组(33.33%,10/30;P<0.01)。ESD组的住院时间和手术时间明显短于RS组(P<0.05)。结论:ESD是一种安全、微创、有效的治疗较大LST的方法。在住院时间、手术时间及短期并发症方面明显优于RS组。

Objective： To compare the safety and effi cacy between endoscopic submucosal dissection （ESD） and radical surgery （RS） for the treatment of large colorectal laterally spreading tumors （LST） larger than 50 mm in diameter. Methods： From January 2011 to January 2016, a total of 82 patients were diagnosed as large LST without deep submucosal invasion （T1 SM2, ≥1 000 μm） in the Second Xiangya Hospital of Central South University. Among them, 52 patients were treated by ESD and the other 30 patients were treated by RS [laparoscopic-assisted colectomy （LAC）/open colectomy （OC）]. The clinic data were retrospectively analyzed and the en-bloc resection rate, en-bloc R0 resection rate, local recurrence, complication, procedure time and hospital stay were collected and analyzed. Results： The lesion sizes were （5.80±1.20） cm and （5.53±0.69） cm in diameter for ESD and RS groups, respectively （P〉0.05）. En-bloc resection rates, en-bloc R0 resection rates and recurrence rates showed no significant difference between the ESD group and RS group （P〉0.05）. Complication rate of the ESD group （7.69%, 4/52） was much lower than that in the RS group （33.33%, 10/30; P〈0.01）. The ESD group also had a shorter hospital stay and operation time than the RS group （P〈0.05）. Conclusion： ESD appears to be a safe, minimal invasive and effective strategy for treating large LST and it is obviously better than RS in the aspects of hospital stay, operation time and short-term complication.