内镜黏膜下剥离术治疗结直肠浅表性肿瘤性病变的术后随访

Postoperative follow-up of endoscopic submucosal dissection for treatment of superficial colorectal neoplastic lesions

[目的]探讨结直肠浅表性肿瘤性病变行内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)后临床病理特征、术后并发症及非治愈性ESD的相关危险因素及追加手术的必要性。[方法]回顾性分析本院因结直肠浅表性肿瘤性病变行ESD治疗的383例患者的临床资料,分析其一般临床特点、病理特征及预后情况并采用Logistic分析非治愈性ESD患者的危险因素。[结果]与治愈性ESD相比,非治愈性ESD患者年龄偏大、病变直径偏大、病理类型更高,差异均有统计学意义(P<0.05),性别、病变部位及随访时间在2组中比较差异无统计学意义(P>0.05)。Logistic分析表明年龄、病变大小、病理类型是非治愈性ESD的危险因素。然而,非治愈性ESD患者外科手术后淋巴结转移及远处转移的发生并无统计学上的差异(P>0.05)。[结论]年龄越大、病变越大、病理类型越高级发生非治愈性ESD的可能性更大,但非治愈性ESD患者在病灶完全切除的前提下,在无淋巴结转移、远处转移高风险时,追加外科手术并非为必须选择。

[Objective]To investigate the clinicopathological characteristics,postoperative complications,non-curable endoscopic submucosal dissection(ESD)related risk factors and the necessity of additional surgery after ESD for superficial colorectal tumors.[Methods]We retrospectively analyzed 383 patients who underwent ESD treatment for superficial colorectal tumors in Renmin Hospital of Wuhan University from July 2016 to July 2019.The general clinical characteristics,pathological characteristics and prognosis were analyzed and Logistic analysis was used to analyze the risk factors for non-curable ESD patients.[Results]Compared with curative intestinal ESD,patients with non-curable ESD were older,larger lesion diameter,higher pathological types,and the differences were statistically significant(P<0.05).There were no significant differences in gender,lesion location and follow-up time between the two groups(P>0.05).Logistic analysis showed that age,lesion size,and pathological type are risk factors for non-curable ESD.However,compared with curative intestinal ESD,there was no statistical difference in the occurrence of lymph node metastasis and distant metastasis in patients with non-curable ESD(P>0.05).[Conclusion]This study shows that patients with older age,larger lesions,and higher pathological types are more likely to undergo non-curable ESD surgery.However,additional surgery is not a necessary option when there is no lymph node metastasis or high risk of distant metastasis,in patients with non-curable ESD under the premise of complete resection of the lesion,