不同直径结直肠早癌及癌前病变行内镜黏膜下剥离术的对比分析

Therapeutic value of endoscopic submucosal dissection for early colorectal cancers and precancerous colorectal lesions of different diameters

目的探讨分析内镜黏膜下剥离术(ESD)治疗不同直径结直肠肿瘤的差异性。方法收集2012年10月至2015年12月中国人民解放军总医院第七医学中心消化内镜中心210处结直肠ESD治疗的临床资料进行回顾性分析,将病灶按直径分为两组(直径≥4.0 cm组和直径<4.0 cm组),进行相关因素的对比分析。结果210处结直肠病变ESD平均手术时间为(50.3±42.7)min,病灶平均大小为(7.98±10.84)cm2;整块切除率91.4%,完整切除率90.5%,治愈性切除率88.6%。穿孔发生率5.2%,迟发性出血率0.5%。与直径<4.0 cm的肿瘤相比,切除直径≥4.0 cm的肿瘤所需时间更长[(79.63±53.91) min比(35.28±24.99) min,P<0.001];病变主要位于直肠(61.97%);侧向发育型肿瘤(LST)以结节混合型为主(54.93%);整块切除率、完整切除率和治愈性切除率均低于切除直径<4.0 cm的肿瘤,其中完整切除率差异有统计学意义(85.92%比94.24%,P=0.041)。直径≥4.0 cm组穿孔率略高(7.04%),但两组穿孔率的差异无统计学意义。结论ESD切除直径≥4.0 cm的结直肠肿瘤,所需时间明显增加,手术风险更高。对于非直肠的病变要更加小心处理。

Objective To study the differences of endoscopic submucosal dissection (ESD) for colorectal tumors of different diameters. Methods Data of 210 cases which were treated with ESD for colorectal tumors at the Endoscopy Center, the Seventh Medical Center of PLA General Hospital from October 2012 to December 2015 were retrospectively analyzed. The lesions were divided into two groups according to different diameters (≥4.0 cm group and <4.0 cm group) for comparative analysis of related factors. Results The mean procedure time of ESD for 210 colorectal tumor cases was 50.3±42.7 min and the mean size of lesions was 7.98±10.84 cm2 . En bloc resection rate was 91.4%, R0 resection rate was 90.5%, and the curative resection rate was 88.6%. Perforation rate was 5.2%(11/210), and the late hemorrhage rate was 0.5%(1/210). Compared with lesions < 4.0 cm, those ≥ 4.0 cm required longer resection time (79.63±53.91 min VS 35.28±24.99 min, P<0.001);and the lesions were mainly located in the rectum (61.97%). LSTs were mainly mixed granular/nongranular type (54.93%);en bloc resection rate, complete resection rate and curative resection rate of the tumors ≥ 4.0 cm were all lower than those of tumors < 4.0 cm. The difference in complete resection rate was statistically significant (85.92% VS 94.24%;P=0.041). The perforation rate (7.04%) was higher in ≥ 4.0 cm group, but the difference was not statistically significant. Conclusions ESD of colorectal tumors of diameters ≥ 4.0 cm requires longer time with higher operation risk. Additionally, physicians should be more careful with non-rectal lesions.