内镜黏膜下剥离术在早期大肠癌及癌前病变治疗中的价值

Therapeutic value of endoscopic submucosal dissection for early stage colorectal cancer and precancerous lesions

目的探讨内镜黏膜下剥离术（ESD）治疗大肠早期癌及癌前病变的安全性、有效性。方法回顾性分析2016年12月至2017年6月在武汉大学人民医院接受ESD治疗的108例大肠早期癌及癌前病变患者的临床资料，分析病灶特征、术后病理特征、术中与术后并发症、术后随访等情况。结果108例患者均顺利完成ESD治疗，中位手术时间为45rain。术中穿孔3例（2．8％），术后无迟发性穿孔，术后迟发性出血3例（2．8％）。术后病理提示管状腺瘤41例（38．0％）、绒毛状腺瘤4例（3．7％）、绒毛状管状腺瘤39例（36．1％），其中伴有低级别上皮内瘤变41例（38．0％）、伴有高级别上皮内瘤变16例（14．8％）；腺癌19例（17．6％），包括高分化11例、中分化5例、低分化3例；其他病理类型5例（4．6％）。病灶均为完整切除，其中整块切除100例（92．3％）。术后平均随访时间为8．1个月，在此期间未发现复发病例。结论ESD治疗早期大肠癌及癌前病变是安全、有效的。完善术前评估，加强手术技能，分析术后病理特征及定期随访是提高ESD治疗质量的重要保障。

Objective To investigate the safety and efficacy of endoscopic submucosal dissection （ESD） for early stage coloreetal cancer and precancerous lesions. Methods Clinical data of 108 patients who received ESD for early stage coloreetal cancer and precancerous lesions from December 2016 to June 2017 in Renmin Hospital of Wuhan University were analyzed. The lesion characteristics, postoperative pathological features, intraoperative and postoperative complications and postoperative follow-up outcomes were analyzed. Results The 108 patients all underwent ESD successfully with median operation time of 45 rain. The rate of intraoperative perforation and postoperative delayed bleeding was 2. 8% （ 3/108 ） and 2. 8% （3/108） , respectively. No postoperative delayed perforation occurred. Postoperative pathology showed that there were 41 cases （38.0%） of tubular adenoma, 4 （3.7%） villous adenoma, 39 （36. 1%） villous tubular adenoma [including 41 （38. 0%） low-grade intraepithelial neoplasia and 16 （14. 8%） high-grade intraepithelial neoplasia] , 19 （17.6%） adenoearcinoma, and 5 （4. 6%） other types. Among the 19 cases of adenoearcinoma, there were 11 cases of well-differentiated, 5 median-differentiated and 3 low- differentiated. The complete resection rate was 100.0% and the en bloc resection rate was 92. 3% （ 100/ 108）. The mean follow-up time was 8.1 months, and no recurrence was found during this period. Conclusion ESD is safe and effective in the treatment of early stage coloreetal lesions. It is important to improve preoperative assessment, strengthen surgical skills, analyze postoperative pathological features and regularly follow up to guarantee the treatment quality of ESD.