内镜黏膜下剥离术治疗巨大结直肠侧向发育型肿瘤的临床研究

Outcomes of endoscopic submucosal dissection for colorectal large laterally spreading tumors

目的评价内镜黏膜下剥离术(ESD)治疗巨大结直肠侧向发育型肿瘤(LST)中的疗效和安全性。方法对150例病灶直径>4 cm的结直肠LST的临床资料进行回顾性总结,分析LST形态分型、部位、病理结果、整块切除率、完全切除率和并发症。结果 150例患者中,颗粒型87例(58.0%),非颗粒型63例(42.0%)。部位分别为直肠109例(72.7%),乙状结肠13例(8.7%),降结肠5例(3.3%),横结肠8例(5.3%),升结肠13例(8.7%),盲肠2例(1.3%)。低级别上皮内瘤变23例,高级别上皮内瘤变104例,黏膜内癌7例,黏膜下癌16例。整块切除率为92.7%(139/150),完全切除率89.3%(134/150)。术中出血8.0%(12/150),术后出血1.3%(2/150),穿孔率为2.0%(3/150),术后狭窄2.0%(3/150)。结论非颗粒型巨大结直肠LST恶变率大。ESD治疗巨大结直肠LST是安全有效的。

Objective To evaluate the efficacy and safety of endoscopic submucosal dissection for the treatment of colorectal large laterally spreading tumor.Methods ESD was applied to treat150cases of colorectal LST with diameter larger than4cm.The morphological features of LST,distribution,the clinicopathological data and the enbloc resection rate,complete resection rate,complications were retrospectively evaluated.Results There were87patients with LST-granular lesions and63patients with LST-nongranular lesions.Colorectal LST mainly distributed in the rectum for109cases(72.7%),sigmoid colon for13cases(8.7%),descending colon for5cases(3.3%),transverse colon for8cases(5.3%),ascending colon for13cases(8.7%),cecum for2cases(1.3%).There were23patients with low-grade neoplasia,104patients with high-grade intraepithelial neoplasia,7with intramucosal carcinoma and16with submucosal carcinoma.The en-bloc resection rate and complete resection rate were92.7%(139/150)and89.3%(134/150).Adverse events were intra-operative bleeding in12patients(8.0%),postoperative bleeding in2patients(1.3%),perforation in3patients(2.0%),postoperative stenosis in3patients(2.0%).Conclusion Colorectal large LST-NG has higher potential for malignancy.ESD is a safe and effective method to provide en-bloc and complete resection of colorectal large LST.